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Building Permit #792-2017 - 102 SPRING HILL ROAD 2/22/2017
NoRTf-/ a '�I AAJ`'�D BUILDING PERMIT °�<tLED �bgtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION A. �b Permit No#: �� Date Received -& —0 J/ �qs RATED SgcHuSE Date Issued: 2 PAPORTANT:Applicant must complete all items on this page • �,""",.`�.` .Prang I pQ�ERYr®WNER1 Pnnt� 7 D rear tructurg NQS nO ®�P ¢P�RCELZONING'D15TR C�1" istori ,D,s'tnct� yss rho opfflilla TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family 0 Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition ❑ Other r �-�'--� °� •---- .-.t. � ,* ,y u� � :z-�-'°r�°�--z:.:�,. �;�.•r•.•°-�-'-;'�.. :� � ;r s � r-�� -.-.°•�s.-ins- �"�-'£t�' w Septic ®1/Vell 41 4 �;'Water�yhed�istn < ^ _;�,;;�iWater/S_ewer .-.t:���-�' ,�'�.� ,�_, �-� ,V..�..�::;:.� ". DESCRIPTION OF WORK TO BE PERFORMED: Com` k tos g 0 Identification- Please Type or Print Clearly OWNER: Name: Phone: Address r.•* .r' € 3�r '"�"-'ate-�- .r-'�-g-.,� ar�t, '�`� ,t � i,+�. g- t Captractor Nariie x �m Erraail �� ` �* Tf E x 7 .� A_dtlres � k.5 _ W1141r to ra ,%{ ter i K rz� G 3 93 d f Sup�ervisor,�s„ C�n�r ction��L�cense• �� "' x Date E i �.*>_.d.K'�. .a•.r'.ira. k M J ti� A _+.,...�... X �' � h ..A.�.�'.,:, �Ho�ne�lmprovemenLlcense �. .�_ �: � ,Exp„;�F�te � �. �-•-�: .e...,..:�; x,•.� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ a):3) 125- - a-� FEE: $ b — Check No.: Receipt No.: 1!�' NOTE: Persons contracting with unregistered contractors dopt 1jv ccess to the guaranty fund nafi irPofAaPnt/Owner Signature f cofor , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F YPE OF SEWERAGE DISPOSAL ublic Sewer ❑ Tanning/Massage/Body Art ❑ Swims g Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Si nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes • Planning Board Decision: Comments "Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDE.PARTMEIVT,� '*Temp �..,�• ..� -� .-��_ -�:.. � # ,� .� P � --y z��:�... ..� ono�,��-�_._.�:����� ,����� �Loaated aft 124iMain§Street •� � ` � = Ae �W .� , ,. g,r.- ,k•.�i 4.,, �,. Amy, 'i"` si kF s - '7' $ Yy .t iw 'k:.%'Fy [ ;�"s' 7=7. FireDepartment,signatiare/date �,' x =y.. ,r ' ; n kt �� ' _�,�; .+� 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) ❑ Notified for pickup Call Email s [ Date Time Contact Name = Doe.Building permit Revised 2014 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 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 2014 Location 1 — 0,42, No. —] 17 — ZG C Date 2 7 (-7 . • TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 Check# Building Inspector o0RTly Town of s ndover 0 .�. No. h ver, Mass, 9 Al COC"to C0441 WICK y1. �ds RATED NPa��S U BOARD OF HEALTH Food/Kitchen PE D Septic System r^ THIS CERTIFIES THAT .�.1,�. BUILDING INSPECTOR . a. M..1'. .. .. ..I.1t1,Q�. J ......... . . ...... Foundation has permission to erect ............. .... ..... buildings on .... .. .... !r�. ... ....... ...!�1.... ,... ` - Rough to be occupied as .....I..�.4..' �A...: ..... .. t........ .... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the*Alication 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 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TIns Rough Service .............. .. ..... ......................... Final #j 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. OWNER AUTHORIZATION FORM Nicholas Rethman (Owner's Name) owner of the property located at 102 Spring Hill Road, North Andover, MA (Property Address) 102 Spring Hill Road, North Andover, MA (Property Address) Merrimack Valley Insulation 23A Sullivan Rd MM Billerica,MA01862 hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner's Sianature Date Federal 10#05.0405629 ,. RISE Engineering IUContractor Registration No 8186 MA Contractor Registration No 120979 RISEA division of Thieisch Engineering CT Contractor Registration No 620120 ENGINEERING 60 Shawmut,Canton,MA 02021 CONTRACT �r a���� 339-502-5197 FAX -502-6345 N Page 1 PROGRAM THIS CONTRACT IS ENTERED BTTO BETWEEN RISE IU[1I IUi CMA-HES ENGINEER04 AND THE CUSTOMER FOR WORK AS OESCRIBEO BELOW CUSTOMER t-r1 PHONE DATE CLIENT/ WORKORDER Nicholas Rethman (978)836-0884 11/272015 420290 00003 SERVICE STREET v C� BRAING STREET 102 Spring Hill Road 102 Spring Hill Road SERVICE CITY.STALE,zw LT 8XUNG CM,STATE,LP North Andover,MA 01845 North Andover,MA 01845 DESCRIPTION ti PHASE TWO-Proposal for next year's weadmization project.Prices and program incentives not guaranteed. $0.00 AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seat your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and othcr unheated areas(windows are not generally addressed.) This will require(8)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cirri is.not guaranteed. At the completion of the wcatheriration work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your Nome can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generaily addressed.) This will require(4)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $340.00 ATTIC ACCESS:Provide labor and materials to insulate(1) back of the kneewatl hatch with 2"rigid Thermax board,and sal the edge of the hatch with weatherstripping. $60.00 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. $237.65 COMMON WALLS:Provide tabor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(90)square feet of common wall area. $315.00 OVERHANG:Provide labor and materials to install 4"R-14 densely packed Class 1 Cellulose insulation to(160)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be scaled t 1 with exterior grade spackle and Icft in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's N responsibility. ) t-t+S r 9-' 1 +YX 8 TWO, $609.60 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed 52,000 per calendar year,and an incentive of 1000/6 for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. g Federal ID#05.0406629 RISE " RISE Engineering R1 Contractor Contractor Registratiationon No 8186 MA Contractor Regtatration No 920979 A division orThicisch Engineering CT Contractor Registration No 620120 ENGINEERING ' 60 Shawmnt,Canton,MA 02021 CONTRACT 339;502-5197 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT E ENTERED INTO BETWEEN RISE CMA-HES ENGM/EERYJO AND THE CUSTOMER FOR INORK AS OESCRJ=BELOW CUSTOMER PHONE DATE CLIENTS WORK ORDER Nicholas Rethman (978)836-0884 11/2712015 420290 00003 SERVICE STREET BIWNG STREET 102 Spring Hill Road 102 Spring Hill Road SERVICE CITY.STATE,ZIP BKAJNG CRY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION 590.00 Total: $2,332.25 Program Incentive; $2,026.69 Customer Total. $305.56 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WTTH ABOVE SPECIFICATIONS.FORTHE SUM OF "'Three Hundred Five&56/100 Dollars $305.56 UPON FMIAL MIS TION AND APPROVAL BY REE ENOMMERIN(L CUSTOMER.AGREES TO REMIT AMOUNT DUE VJ FULL INTEREST OF i%VADA.BE CHARGED MONTHLY ON ANY UNPAID R 70 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECTSKTN,SCHEOIAJNO,ANO CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERSW ANY BLANK SPACES AUTHORIZED SKiNATURE-RISE EPghmwhV CUSTOMER ACCEPTANCE NOTE THIS CONTRACT MAY BE VOTHDRAWN BY US IF NOT EXECUTED VRTHIJ OATS OF ACCEPTANCE ✓ A 0 ACCEPTANCE OF CONTRACT.THE ABOVE PRICES,SPECFTCATJONS AND CONDMON5 ARE 30 DAYS. SATMFACTORY TO US AND ARE HEREBYACCEPTED.YOU ARE AUTNOR&=TO DO THE WORK AS SPECMTEO.PAYMENT WDLL BE MADE AS OUTLMJED ABOVE The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ?r 1 Boston,M4 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individaat): Merrimack valley Insulation Corp. Address: 23 A Sullivan Rd. City/State/Zip_Billerica_MA 01862 Phone#: 978-888-3495 _ f Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 18 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ 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 S. Demolition working for me in any capacity. employees and have workers' 9. Q Building addition [No workers'comp.insurance comp.Vance required.] 5. ❑ We are a corporation and its 10.M Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 1351 Other Insulation comp.insurance required.] =Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. llomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have empioyees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I wn an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information- Insurance nformationInsurance Company Name: 5Star V3 AAIC American Alternative Insurance Policy#or Self-ins.Lic.#: V9WC749118Expiration Date: 6/18/2017 Job Site Address: , //J & 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 hereby certify under the pains and penalties ofperjury that die information provided above is true and correct Signature: Date: o? Phone#: 8-888-349 Official use only. Do not write in this area,to be completed by city or town offwiaL 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#: MERRVAL-03 WEJE CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 6//93/21312016 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 NACT AME: Automatic Data Processing Insurance Agency,Inc PHONE i FAX I ADP Boulevard EMAC No Ext); AIC.No): IL Roseland,NJ 07068 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 INSURERA:5Star V3 AAIC American Altemative insuran• INSURED Merrimack Valley Insulation Corp INSURERS: ^-�- 23a Sullivan Rd INSURER C; North Billerica,MA 01862 INSURERD: INSURER E• _ --•v — -- 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 PER16D 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. IN SRI ��_----TYPEOFINSURANCE _---__ADL SUB t-`—'—"—' "—_ POLICYEfF 7 POLICYEXP - LTR 1NSR INVD POLICY NUMBER MMlDDIYYYY 1 MAtID LMRS GENERAL LIABILITY ( ;EACH OCCURRENCE j S COMMERCIAL GENERAL LIABILITY I MAETORENIED (� i PRE?�ISES�Ea occurrence S CLAIMSWADE U OCCUR { MEDEXP(Anyone person) i S ` PERSONAL&AOV INJURY S f GEN_ERALAGGREGATF _ S GEN'L AGGREGATE LIMTi APPLIES PER: i PRODUCTS-CO_MPIOPAGG 5-----_ — POUCY r ;SPENT j LOC i I ( S AUTOMOBILE LIABILITY i i I i COMBINED SINGLE LIMIT Ea accident S _ ANY AUTO i BODILY INJURY(Per person) 5 ALL AUTOS OWNED SCHEDULED AUTOi I BODILY INJURY(Per aWderd) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS P PER S UMBRELLA LIAB OCCUR ' EACH OCCURRENCE S_ EXCESS LIAB CLAIMS MADE AGGREGATE _ S DED RETENTIONS �— S �_-- WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN A ANY PROPRIETOR/PARMERIEXECUTII(e SWC749118 611812016 &/18/2017 E.LEACH ACCIDENT $ — 1,000,00 01FICCEERRIMElMBEP.EXCLUDED? Q NIA — IF yes,(Mad atarlidescribe Iunder - E.L.DISEASE-EA EMP — S _ 1,000,00 DESCRIPTION OF OPERATIONSbeiv:, i E.LDISEASE-POUCYLIGrtrr 5 1,000,00 i E I DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEMBEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andoier,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andooer,MA 01845 UTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AlC V DATE(MWDDVYYM `Iliw CERTIFICATE OF LIABILITY INSURANCE 02/18/2017 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 have ADDITIONAL INSURED provisions or 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 Carolyn A Coughlin Charles J Coughlin Insurance 14 Dnley Street PHD� . (978)957-3588 arc : R O.Box 10 SSS carolyn(cDcoughtnins.com Dracut,MA 01826 INSURERS)AFFORDING COVERAGE NAIC# INSURERA: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation INSURERS: Safety Standard 39454 Joseph A.Ryan,Jr. INsuRERc: Starstone is Yinsurance Corrpany A0242 23A Sullivan Road R Billerica,MA 01862 INSD INSURER E: INSURERF: 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. iLTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/D Y EFF POLICY EXP IYYM LIMITS A COMMERCIAL GENERALLIABILITY VM04833 01/21/2017 01/21/2018 EACH OCCURRENCE $ 1,000,000 CIAIMS MADEE2 OCCUR DAMA RENTED 100,000 PREMISES Ea occurrence $ _ MED EXP(Ary one person) $ 5,000 PERSONAL BADV IMURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY 0 EC FI LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY 6205006 11/25/2016 11/25/2017 CEa acc dartOMBINED SINGLE LIMIT $ 1000 000 ANY AUTO BODILY INJURY(Per person) $ OWNED / LED AUTOS AUTOS ONLY �/ AUTOS BODILY INJURY(Per accident) $ HIRED / NON-0VV ED PROPERTY DAMAGE AUTOS ONLY V AUTOS ONLY Per accident $ C �/ UMBRELLALIAB OCCUR 875931-172ALI 01/21/2017 01/21/2018 EACH OCCURRENCE $ 1,000,000 EXCESSLIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$0 $ WORKERS COMPENSATION PER OTFF AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEREMBEREXCLUDED? F—] NIA E.L.EACHACCIDENf $ /M (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ l yes,describe oder DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 9 more space Is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION Fax#:(978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M Town of North Andover,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD ,� �- ,. �?/�� { f��l?f��?��?,f,(1P.C�'f�f1• f1��../l/GGZ�.f�'C'f?,�G.���1• Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration iY*~, i ';= Type: Corporation v: Registration: 180506 Merrimack Valley insulation Corp :_ Expiration: 1 1/231201 8 23 A Sullivan Rd Billerica, MA 01862 _ Update Address and return card. Mark reason for change. SCA i C 24WO5,111 Fl Addsp-, 01 gennvs , n=MVIni orst 1`11 ncjt f`arri cti '''//r��n�rr»>r.�rurrrtl/✓r�^?��surrleu;rh's 1 office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Corporation before the expiration date. If found return to: F!} Registration Expiration Office of Consumer Affairs and Business Regulation < � r10 Park Plaza-Suite 5170 180506 11123/2018 Boston,MA 02116 Merrimack Valley Insulation Corp Joseph Ryan 23 A Sullivan Rd i l --- Billerica.MA 01862 Undersecretary 1f N6t v id ithout signature t Massachusetts Department of Public Safety ' Board of Building Regulations and Standards License:CS-075541 Construction Supervisor ' JOSEPH ALEXANDER RYAN,JR ' 366 OLD WESTFORD RD CHELMSFORD MA 01824 / ; i1•_ , ~2�- Expiration: it ion' P Commissioner 02/04/2019