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HomeMy WebLinkAboutBuilding Permit #387-2016 - 1041 FOREST STREET 9/25/2015 ORT BUILDING PERMIT TOWN OF NORTH ANDOVER ° 1. o APPLICATION FOR PLAN EXAMINATION '` OL Permith!0: �� �� Date Received Date Issued: 19,1d,6 SSACHU`�� IMPORTANT: Applicant must complete all items on this page LOCATION. I0LA 1 SWzge I ori`k At)c�+y:✓ �j Print PROPERTY OWNER vJ n t"PC Ptint MAP NO: i PARCEL: ZONING DISTRICT: Historic District yesFn !Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building L- One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other Ca Septic . Well Floodplain Wetlands Watershed District ❑ Water/Sewer c� a50 0 0 t Identification Please Type or Print Clearly) OWNER: Name: QPJV'- No's--y- Phone: &0 `�- (n I=1 Address: CONTRACTOR Name: ICd � -Oqd4 Phone: Address: A-r A \��' i-�i , Sq�e ryi MA 06,70I Supervisor's Construction License: Exp. Date: C ` � � 5A(P dOI Home Improvement License: 10 �09 Exp. Date: © (D 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: $ ] 9 q(p FEE: $ Check No.: c21$6 Receipt No.: `t1� NOTE: Persons contracting with unregistered contractors do not have access to tkvgu ranty fund _ f Signature of Agent/Owner 1 Signature of contractor r BUILDING PERMIT of No 0 6gti O r y I 1 .,,.*6 O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 2 w 1. Permit No#: Date Received 'LA0 Are gSSACHUSE� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 ❑ Septic u Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: i Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Ag--- caner Signature of contractor Location leg i No. Date .;d hr- w . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ . Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ . TED TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ `bfamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ (COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street F!RE DEPARTMENT - Temp Dumpster on site yes no Loeated at 124 Main Street Fire Department signature/date COMMENTS Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street - - Fire Department signature/date COMMENTS 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 Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ 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 Doe:Building Permit Revised 2014 NORTH own of E ndover 0 397_ amy Z " , ver, Mass, COCNICNlw1CN y1' A�R^TEo 01"P,`'�5 S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... w^� 'e .S ........................................... ............................. BUILDING INSPECTOR ........... ...... Foundation has permission to erect .......................... buildings on ..... ... �bO1. ... . ..�e4....... .. ...a��-................. . � Rough tobe occupied as ........ .. . . . .P....... ...r ......................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST TS Rough Service .......... ....... .... .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �, /� �p�/�,/1r A & A SERVICES, INC. A&A SER ICES 115 NORTH STREET, SALEM, MA 01970 • ••• Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Bu er(s Name Date of Contract Bu er(s) Street Address,Citv State and 7in Code L/0 V1 57'- �. n ✓ O/ Daime Tele hone Number Evening Telephone Number Mobile Telephone Number E-Mail Address The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contractor"),hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services.The Buyer(s) agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. Wt: — Est. Purchase ocf i/ cEst.Starting Date:QuDown Pay Completion Dateo—gL � 0 Cash Amount Due on Start of 'b: 9 3 ` Check 0 Amount Due on Credit Card of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completi n:.�33= CVC Code: It is agreed and understood by and between the parties that this Agreement, front and back and any addendum, constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyer(s) hereby acknowledge that Buyer(s)has read the front and the reverse of this agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms,on the date first written above.Buyer(s)also(i)acknowledge that they were orally informed of their right to cancel this transaction;and(it)request that they be contacted via their telephone numbers or email,as listed above,in the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A .. r,y ices,If '. Buyer(s) By: 0f Signatures Signature Print Name Dn ton e Print Name Signature Print Name You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The contractor and the homeowner hereby mutually agree in advance that in the event either parry has a dispute cenceming this contract,either party may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Afla7nd Business Regulations and the other party shall be required to submit to such arbitration as proved in M.G.L c.142A. Cnmracior initials:e"2 Buvc's Initials:_ D.w 9' vY /S Darc:r y Lf-Ir NOTICE OF CANCELLATION NOTICE OF CANCELLATION Date of Transaction -/y-�S .You may n,without an penalty or Date of Transaction 9 y y cancel this transactioitht y p �' '�) .You may cancel this you cancel, without any penalty or obligation,within three business days from the above date.If you cancel,any property traded in, obligation,within three business days horn the above date.If you cancel,any property traded in, any payments made by you under the Contract or Sale,and any negotiable instrument executed any payments made by you under the Contract or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled.If you cancel,you must and any security interest arising out of the transaction will be cancelled.If you cancel,you must make available to the Seller at your residence,and substantially in as good condition as when make available to the Seller at your residence.and substantially in as good condition as when received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk.If you do make the goods available to the Seller and the Seller does not pick expense and risk.If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date o1 your Notice of Cancellation,you may retain or dispose of the them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of goods without any further obligation.11 you fail to make the goods available to the Seller,or it you the goods without any further obligation.I1 you fail to make the goods available to the Seller,or if agree to return the goods to the Seller and fail to do so,then you remain liable for performance of you agree to return the goods to the Seller and fail to do so,then you remain liable for performance all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancellation notice or any other written notice,or send a tele ram,to A&A SQrvices, copy of the cancellation notice or any other written notice,or send a tel m/to A&A Services, 115 North Street,Salem MA 01970,NOT LATER THAN MIDNIGHT OF�'/� -/{ . 115 North Street,Salem MA 01970,NOT LATER THAN MIDNIGHT OF 7 rnatet maml I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION Consumer's Signature Date: Consumer's Signature Date: A+ Phone: 978-741-0424 Abrade Above Fax: 978-741-2012 Since 1982 www.a-aservices.com A&ASERVICES 115 North Street • • Salem, MA 01970 Date: Work Specifications for Roofing Project Name: r, Address: City:/!�,��,�K, State: Zip Code: s— Areas to Be Re-Roofed: Roof Areas Excluded from Re-Roofing: Pull Permit with Community as Required. S Waste disposal is included using either dump truck or dumpster. If dumpster is utilized (site location: as agreed to by the home owner), it will have plank stock put under dumpster as ty protection \— proper . ` J Tarp house from fascia board to ground and beyond to protect house from falling roof shingles. A&A Services makes every attempt to protect home, decks, driveways, landscaping, and shrubs. Due to the heavy weight of roofing shingles coming off the home we cannot be responsible for damage to landscaping and shrubs. Strip roof of_layers of roofing shingles. Inspect roof deck after removal of shingles for any rotted wood. If any replacement is needed, the first 32 sq.ft. is included. For any other repairs: 4x8 sheets of plywood removal and replacement will be billed at $ per sheet. The charge for resheathing deck with 1/2"of plywood (go over existing roof deck), if needed will be $47 per sheet. Planking replacement is billed at $ per linear ft., and carpentry ` repairs at $ per hour. d Install GAF storm guard leak barrier 6' up roof from edge of fascia board (code calls for 3'). A&A Services is dedicated to using extra ice dam protection in our unpredictable New England weather. GAF storm guard leak barrier/ice dam protection material is a flexible membrane that sticks to the roof deck to prevent it from moving when shingles are installed over it. This membrane self-seals when nails are driven through so water cannot leak through it. Install GAF storm guard leak barrier 18" in from edge of rake (eave areas of the home). This prevents wind-driven rain from penetrating the edge of your roof and causing leaks. Buyer Initials: ; Date: Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan.2015(2).docx �+ Phone: 978-741-0424 A Grade Fax: 978-741-2012 Above ®��® ®, Since 1982 www.a-aservices.com J17{� A SER Y 'CEO 115 North Street \ • • Salem, MA 01970 �7 Install GAF storm guard leak barrier 36" in valleys of home and at any roof penetration such as chimneys, \ exhaust vents, vent pipes and skylights for added protection against leaks. L�7 Install F-8" drip edge to perimeter of the roof deck. Drip edge helps support the roofing shingle at all edges of the roof, manages water flow off roof and into gutters, and also protects against wind-driven rain penetrating the edge of the roof. Available in 3 colors: Mill (Aluminum), Brown, and White. Install GAF deck armor to remaining area of the roof that is not covered with GAF storm guard. GAF deck armor adds another layer of protection against leaks from wind-driven rain. It being extremely breathable, \ lets moisture escape from attic space and helps preserve your roof deck. © Install GAF ProStart starter shingles at perimeter of roof. This is important because the starter shingle has \ additional adhesive which prevents the first row of shingles from blowing upward in heavy winds. © Re-flash chimney: remove and dispose of old flashing, cut into mortar with grinder approximately 8" up chimney, feed new lead into newly cut mortar joints, install lead in a step-flashing manner, and run approximately 4" onto roof deck. Seal all edges with Geocell sealant. Lead is used as a flashing material on chimneys because it is very pliable. Lead flashing molds to uneven surfaces and stays in place for years. Install aluminum vent pipe boot with rubber gasket around all vent pipes and then seal with Geocell sealant. This application prevents leaking around vent pipes. ❑ Replace or ❑ Cut in For & Install Broan roof bathroom exhaust vent(s)with adapter and seal with GeoCell. Ventilation is a requirement for long-term roof performance and warrantee validation. It will reduce energy consumption and create a healthier and more comfortable home environment for you. A&A Services will utilize the following type of ventilation system for your home: Gable Vents: Add: • Utilize Existing: • Expand Existing: Soffit to Ridge: (Soffit Vent as Intake)Add: Type: • (Ridge Vent as Exhaust) Cut in as required and add GAF Snow Country Baffled Ridgevent to ridge(s). Location: Aluminum Slant Static Roof Vents: # 7 Location: 3 0,-► Gc r���. 3 �„ /d��;;,,��f / , 2 Mechanical Ventilation (Electrician Not Included): # • Type: Location: Buyer Initials: Date: Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan.2015(2).docx ®R f Phone: 978-741-0424 7�,t Abrade Above Fax: 978-741-2012 Since 1982 www.a-aservices.com A&ASERVICE5 115 North Street o • • • Salem, MA 01970 Install GAF Roof Shingles Style: //.G Color: Nail locations vary by shingle and roof slope. It is critical to fasten the shingle in the proper locations in order to achieve desired performance and meet warranty requirements. • All nails that will be used on your roof will be barbed or rough-shanked nails and will be resistant to corrosion. • In most applications, shingles will receive 6 nails and all nails will be long enough to penetrate min. 3/4" into the roofing deck. (Using 6 nails per shingle and utilizing ProStarter shingles at rakes and soffits upgrades the wind rating of your roof to 130 mph. ❑ Install GAF Timbertex premium ridge cap shingles with approximately 8" exposure. These shingles add the finishing touch to the peak and/or ridges of your home. They are also designed to handle some of the toughest areas of roof protection. TimberTex ridge cap shingles are much thicker and have self-sealing adhesive that seals each shingle tightly and helps reduce the risk of blow-off. Install GAF Seal-a-Ridge Cap Shingles with approximately 5" exposure to ridges. Clean off roof with blower to remove any debris. Clean out gutters of any roofing debris. Rake clean all work areas. Leaf-Blow the perimeter of work areas. Go over grounds with magnetic rake to pick up any loose nails. Please note: you may want to cover your attic belongings due to roofing debris sometimes \ falling through the gaps in the roof deck. That cleanup is not included. �l This is a safety equipment project. We value our help and are concerned for your liability. 7 Supply owner with partial leftover bundle of shingles to have in the future if needed. A&A Services is a certified GAF installer. We follow all Massachusetts building codes and GAF manufacturer's installation requirements. By doing so, your roof qualifies for a 50 year non-prorated warranty from GAF. See warranty for more details. Massachusetts Law requires contractors to warranty their work for 1 year against installation defects. A&A Services offers warranties for their roofing work for 10 years against installation defects. If any problems occur at any time, A&A Services will come out free of charge to evaluate and help our customer through any manufacturer's warranty claim. ❑ Miscellaneous: _t�v�ip�� go, r,- (�,'K, y� J 6T"- buyer Signature Salesman Sig-nature !� r paY, Date: 9-N-6 ���� �c �� Date: Buyer Print Salesman Print Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan.2015(2).docx Phone: 978-741-0424 1982-2012 Fax: 978-741-2012 www.a-aservices.com 115 North Street o a " Salem, NIA 01970 DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a property licensed facility as defined by M.G.L.c. 111, Sec. 150a. The debris will be disposed at: Republic of Boston, Dumpster Service at 115 North Street Salem, MA 01970 Signature of P rmit Applicant Christopher Zorzy, President Name of Permit Applicant Date z. -- The Commonwealth of//Massachusetts Departmen/of Industrial Accidents Office of Investigations 600 bbashin;ton Street, 7�l`Floor .a Boston, Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors .applicant infoirmation: Please PRINT legibly n �-a/L� address: �� ! `�' �•I Y, an cite state" work site location(bill address) I 0 T 1 1C01-,e5+ ❑ 1 am a homeowner petfotmtng all work myself. Project Type: ❑New Construction []Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition I all, an employer providing workers' compensation for my employees working on this job` companv name: l? _t,- address: f address: f ! .� /^✓�'� � ti j—• city: /nom Nt l� plione#• 15' 7 7 i Q V L/ insurance Co. 71--i' '-a+J�e (-C r- policy # (�),-u( ? ❑ 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed belOW�Nho ha%,e the followinu workers' compensation polices: company name. address: city: hone#: insurance co. olicv# company name: address: City: ltone#: insurance co. oliev# :Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of.MGL 152 can lead to the imposition of criminal penalties of a line up to S1,5ol).011 and/or one years'imprisonment as well as civil penalties in the form ora S,rop NVORK ORDER and a fine ofsloom a day against me. I undecsLuu1 that a copy of this statement may be I'ortvarded to the ffice of lovestigations of the DU for coverage verification. /fila hcreGt/cerlif un(e Ih'pants gird p nrdties of perjury that the information provider/above is true and correct. Signature/ /'J► s Dale Print name Q'I / l 1 f OSI 1 _ f O�/ Phone# 7 r '7 t{ official use only do not write in this area to be completed by city or town official city or town: permit/license k ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office contact person: ❑Health Department tre6seJSept 'ant phoned; ❑Other A CERTIFICATE OF LIABILITY INSURANCE DATE(M 9/15 5 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ,.ePORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The John M.Sullivan Insurance Agen PHONE 781449-9330 FAX 781 449-3511 P.O. Box 920047 AIC No Ext: A/C No Needham,MA 02492 aDDRess: sullivan.insadv@verizon.net INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:The Travelers Indemnity Co 11347 INSURED INSURER B: A&A Services, Inc INSURER C: 115 North Street INSURER D: Salem, MA 01970 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE rI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROECj LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DE I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 9/13/2015 9/13/2016 E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBER EXCLUDED? N/A 6KUB-0243M81-5-15 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT It son non DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additlonal Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '-ding 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. th Andover, MA 01845 AUTHORIZED REPRESE E ©1988-201 If ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Certificate No: A044298 THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT DEPARTMENT OF LABOR STANDARDS 19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114 I DELEADER CONTRACTOR LICENSE I A&A SERVICES,INC. 11.5 NORTH STREET SALEM MA 01970 LICENSE: DC000440 EXPIRES: Saturday,June 25,2016 IN ACCORDANCE WITH M.G.L.CH. 111, § 197B(b)AND 454 CMR 22.03,THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK. THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L.CH. I I I § 197B(b)(2)AND 454 CMR 22.03. WILLIAM D.MCKMEY,DIRECTOR p Massachusetts -Department of Public Safety rr. auurrrrtrurrr/�rl`"( l�ri��nr rarr//"r -� Office of Consumer Affairs&Business Regulation Board of Building Regulations and Standards N3= _ OME IMPROVEMENT CONTRACTOR Urinstructior,Sunervisor ration: 101609 101609 Type: License: CS-057733 Expiration: 6/26/2016 Private Corporatio r CHRISTOPHER b �. Ple 4&A SERVICES,INC 115 NORTH ST s C1 Salem MA 019707 Christopher Zorzy 115 North Street Salem,MA 01970 Undersecretary ✓� iA Expiration Commissioner 05/26/2017 A&A SERVICES,INC. 115 NORTH STREET SALEM,MA 01970