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HomeMy WebLinkAboutBuilding Permit #811-2017 - 1094 SALEM STREET 3/2/2017 tkORTF/ BUILDING PERMIT ,�? 4`;,, � �1 C TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIlD Permit NO: 'go/7 Date Received 2Q gOwATeo tPP�1y Date Issued: 3SAC U IMPORRTANT: Applicant must complete all items on this page LOCATION ®q 7 �l''rL6rh ► (� Print PROPERTY OWNER i GIC I Lt1 1lJ 6 Print MAP NO: PARCEL: ZONING.DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑New Building ROne family ❑Addition 0 Two or more family 0 Industrial ❑ALteration No. of units: ❑Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition 0 Other 0 Septic ❑Well ❑Floodplain D Wetlands 0 Watershed District ❑Water/Sewer : r fl)w K w, M to 6-4f u vl f " D /,t/f L .F, &f?*LL 7 grAe&Lz#1 Gtr 1XIIAlD©,��-,cf� f 64 Identification Please Type or Print Clearly) OWNER: Name: _ _k 1 cg l( LL L IZ Phone: Address: l D L/ 5-7-, CONTRACTOR Name: Phone: f Ca Address: Supervisor's Construction License Exp: Date: Home Improvement License: Exp. Date: 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. r. Total Project Cost: $ ' 6,4 _ FEE: $ y� Check No.: Receipt No.: 3/S 7 9 NOTE: Persons contract g wi un gist red contractors do not have access to the guaranty fund Signature o Agent wner Signature of contractor BUILDING PERMIT NoRT" a - o TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION " * 0 j Permit No#: Date Received �SSACHUS�� Date Issued: LVVORTANT:Applicant must complete all items on this pag�*e 17 Iv+.tC� .«tn'y Xi.'FMS'4$.+«,t+}�i'4yt .T3 �f3¢t' r"rit^ :�v;'.4xd 4p•`�i+.Xik�t�.i';.�y�e w`--�..l!'^.'an�.�",rz�"t r,y.'j..'':�'s9'�„� ".[6.}(g`','x a #�.ti*t�a'�`.. ma 4101 �rer +f sy LOCAT,10Ni'i Y;.�rr'wer4;ty.�T�2sr{f,ra a..ti..y ;3 "' «?f` �'-' '�4 r! .a a. ;cC*'W .z, e' wrrrs. �^' .},ns�,. a,^ i•'�""'°'� ^. y *'�,,, t ,,,- p.w .:.�.�. ��.: Y�.x.s � � � .I.,{,r}��+-� ,x.., ..��" �.�e�.-.` ` 1?ROPERTYI,OWNER _..a __ ;.,€ � �' .. ' �� s *tx` " X f -� 10DYearSfructure ' ` .►yes no 7t �„�a _ ir� ` "�^ ,`•3, tPnntyr4.. -'.'�` �r `�'. -',�':y*,v� , 5.. (VIAP �• , PARCEL - ZONING DISTR10?! �} �--� Historie4Distnct -. yest -ono < 'r':N - - -- -yes. - Machine Shop Village. n,: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ` ❑Alteration No. of units: ❑ Commercial ElRepair, replacement D Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic Well ❑ Floodplain D Wetlands D Watershed Distract.. ...,4 Water/Sewer, - DESCRIPTION OF WORK TO BE PERFORMED: i Identification- Please Type or Print Clearly' OWNER: Name: Phone: Address: FFA ntractor. Name: Phone,,dress: SoiLceupervisors Construct _ Exp. Date 4 one 1mprovement Liceriese _ ._ Exp_ Date ARCHITECT/ENGINEER Phone: 7 Address: Reg. No. t FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. 1.---,notal Project Cost: $ FEE: $ Check No.: Receipt No,,- NOTE: o,,NOTIE: Persons contracting with unregistered contractors do not have:access to the guarantyfund Sigr ature o igent,40wrler Signature of contractor i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. -� r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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) D Building Permit Application j ❑ Certified Proposed Plot Plan j ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) o Copy o CContract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TYPB'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 z ' Water &b Sewer Connection/signature Date Driveway Permit 4 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_, - ,, -)imension 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10o-$1000 fine NOTES and DATA— (For department use) � I ❑ Notified for pickup Calf Email ate Time Contact Name Doc.Building Permit Revised 2014 I l: —.- Location 1 L' �� �q f. No. I a C7 i Date f • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ y (—� Foundation Permit Fee $ Other Permit Fee $ I- TOTAL $ . - Check# oy F V 9 C�� Building Inspector � NORT1y Town of ndover �►i nh - 0 ver, Mass,COCHICHlwKK 7.9 A°AATEo 0'P�,��(5 S U BOARD OF HEALTH Food/Kitchen ' PERMIT T LD Septic System • THIS CERTIFIES THAT .....M.Wk ....... .�4I.. ............................................................ BUILDING INSPECTOR AT4.......SAIRM....... ....... Foundation has permission to erect .......................... buildings on ..........(.... Rough to be occupied as ... JU. . ......St. t.1119...... ..�� �.�ll.�.�.�..�V...... S 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 CONSTRUC N 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. about:blank i n 21, 'li,C a w {wc s . "sad: dwY.s . � RMQlh1G At lliRC�Y +[EIV 4�3R11KNT '. E�it�}ttr4 Yt d f!# tt fl {tt t the At�ty •, Pts e t uffibe: � au 2t,,20,11, Rick mo 104 SAWqkg WlYP rt t iC titd abOb t arrrby lotnty andgjijar lCy [ Std° tit ht t '# f 5 dt f t3hrifitr9,ai Q}YY@t i 0—modolCa tr ant9 to nd ( ctnteacW)in it t me with prir��and tdttit� WOW tri its 8psge OW rrtt�5t"widifae E'rodom it€rpt n ,E whk, tr tit tird prier tat ttad A r erri r ( ti llb iy" A r r ta,t , marls A S sit rbc l�of t taerds rrzt s ry t auyer{s)4toes to pay the Wst of the O o Sees purcnas ea et a taerein<t at tirrtin��r exrprt'rt.et�riy itraaricttt��uyr{s°�` y k i�r ihstt ltut � -� $�����,� irrrGiaaata {k$ �.t�ett�e5t Pft3 tr1ltttl8tltilltiittt3ittitAWK "ANN-Ytd, �$ � (, D xA .t'Ii', t'Jtl4 errs t � a, Stil1'tetod-t'e od Sti is rbninl tizast> F �, �hritudF ANt�rs �! � inrltrr��t d tk� erttraYs+$ e€�#ihpt� trr mak . �ttrornrrr cs� � W. 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'M 1 of 1 2/7/2017 3:12 PM 4 National Headquarters Rick and Sue Miller a 2501 Seaport Drive,Chester,PA 19013 32-31648 888-736-6335 January 21,2017 ® WWW.POWERHRG.COM MA HIC#168616 PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 32-31648 January 21,2017 Rick Miller Date of Agreement Sue Miller (978)686-4593(Home) 1094 Salem St North Andover,MA,01845 County:Essex Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification sheets, in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively,this"Agreement"). Pre Installation Inspection Date:Your pre installation,inspection is tentatively scheduled for Tue 1/31 between 9:00a and 10:00a. I Siding/Trim-Cedar Tech Wall System Inclusions: Includes Raindrop Underlayment, PowerWall form-fit adhered insulation,all J-channel, starter strip, inside and outside corner posts where applicable, installation,clean up and haul away of all job related debris. To protect our clients, Power HRG includes at no additional cost,the removal and replacement of up to 300 square feet of soft or rotted plywood if needed.Any additional wood replacement needed,over and above.the 300sq/ft we provide,will be done ata cost to the homeowner of$3.57 per sq/ft.(Buyer initials ) Windows-SL 2700 Inclusions: Includes metal reinforced meeting rails and nighttime safety locks on double hung windows only,welded corners,foam injected frames, Sashlite technology, Heatshield, Duraglass,exterior custom capping, installation, clean up and haul away of all job related debris. It is agreed and understood by and between the parties that the product Specifications, along with the Custom Remodeling and Improvement Agreement,constitutes the entire understanding between the parties,and replace any and all prior negotiations, representations,or agreements, either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractbr. Buyer(s)hereby acknowledge that Buyer(s)has read the Product Specifications. I have read and received each page of this 4 page agreement. Power Home Remodeling Group Buyer(s) Buyer(s) /01/21/1 /01/21/17 _ /01/21/17 Signature of Remodeling Consultant Signature Signature Michael Pappas Rick Miller Sue Miller 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 ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. i January 21,2017 14:38 IIIIII VIII IIII IIIIII VIII VIII IIID VIII IIII III Page 1 of 4 `-, National Headquarters Rick and Sue Miller 2501 Seaport Drive,Chester,PA 19013 32-31648 888-736-6335 January 21,2017 ® WWW.POWERHRG.COM MA HIC#168616 Project Specifications x4 Siding/Trim: Siding 1 2450.0'x1.0' SIDING/TRIM: Models Cedar Tech Wall System Styles Straight Types triple 6"Configs None OPTIONS: Siding Color Greystone Corner Post Color Aspen White Removal Vinyl Installation Details None Sidingrrrim: Fascia 1 250.0'x1.0' SIDINGITRIM: Models Trim&Accessories Styles Fascia I Eaves I Rakes Types Standard Configs None OPTIONS: Color White I Removal None I Installation Details None Sidingfrrim: Soffit 1 180.0'x1.0' SIDING/TRIM: Models Trim&Accessories Styles Soffit Types Standard Configs None OPTIONS: Color Aspen White I Removal None I Installation Details None SidinglTrim: Capping 18 1.0'x1.0' SIDING/TRIM: Models Trim&Accessories Styles Capping Types Windows Configs Standard OPTIONS: Color White I Installation Details None I SidinglTrim: Door capping 7 1.0'x1.0' SIDINGITRIM: Models Trim&Accessories Styles Capping Types Doors Configs Entry Doors OPTIONS: Color White I Installation Details None I January 21, 2017 14:38 IIII I IIII III IIIIII VIII IIID VIII I III IIII IIII I Page 2 of 4 National Headquarters Rick and Sue Miller 2501 Seaport Drive,Chester,PA 19013 32-31648 888-736-6335 January 21,2017 0 WWW.POWERHRG.COM MA HIC#168616 Project Specifications Gutters: Gutters 1 180.0'x1.0' GUTTERS: Models Gutters Styles Gutters Types 6K Seamless Contigs None Options Color: White Installation Details None Gutters: Downspouts 1 120.0'x1.0' GUTTERS: Models Gutters Styles Gutters Types 3x4 Downspouts Configs None OPTIONS: Color White I Installation Details None January 21, 2017 14:38 III) III IIIIIIII IIIIIIIIIIIIII Page 3 of 4 National Headquarters Rick and Sue Miller 2501 Seaport Drive,Chester,PA 19013 32-31648 888-736-6335 January 21,2017 6 WWW.POWERHRG.COM MA HIC#168616 — Project Specifications M, Windows: Windows 31.0'x54.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs Nobe OPTIONS: Color White/White: Grid Pattern: None Removal Wood Additional Details None January 21, 2017 14:38 IIIIIIII I I IIIIIIIIIII II I I I VIII IIII IIII Page 4 of 4 Wilx xtr ,SER SL2700 DOUBLE HUNG WINDOW VINYL FRAME DOUBLE GLAZED FOAM FILL GRIDS LCVV E I ARGON C R 10 010 7,21.01 00486344/001 wom ENERGY PERFORMANCE RATINGS ADDITIONAL::PERFORMANCE RATINGS n 3 r .^ 2iC T° V° C3# M ^ty, i y i3 5F j'li�sEd Q Y'C+jM1I'Y 6. Gt i�f C✓ fit' l�� ttt4 &c FtE (qt&t+f €£"yK a FWLG,E:C „Y"�,4 @G•�rlr 4" , � c..€�'�tf,.LL ,,"�:d'91 �S.V!..3�„tT� .rr r14 c,q .... _ FA IN is' l u The Cortntwiwealth of Massachusetts tr Departinent oflndttslrialAceidews I Congress Stretxt,Sidle 160 —� Boston, AIA 02114-2017 * f� w►vtv.mass.golr/dia Workers'Compensation Insurance Affidavit: Buildoi-s/ContraclorsiElectricians/Plumbers. TO BE FILET)WITH THE PERi1gITTINC AUTHORITY'. Applicant lnforinalion Plc tee Ptitu 1 c�r,hh Name(Business/organization/h,dividual):Power Home Remodeling Group Address:2501 Seaport Drive City/State/Zip:Chester PA 19013 phone#:610-874-5000 ext 2509 Are you an employer?Check the appropriate box: ].❑✓ I am a employer with 20 employees(full and/or part-time),* Type of project(required): 2.7 I am a sale proprietor or partnership and have no employees working forme in 7. E] New construction any capacity,(No workers'comp.insurance required.) 8• ❑Remodeling 3.O l am a homeowner doing all work myself.(No workers'comp.insurance required.]' 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on nY property. I will 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.' 13. Roof repairs 6.[:]We are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑✓ Other 152.§1(4),and we have no employees.(No workers'comp.insurance required.) ~� }Any applicant that checks box 9l must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor;must submit a new affidavit indicatingsuch. :Contractors that check this box must attached an additional sheet showing the name of the sub-cenvactors and state whether or not those entities have employees. If the sub-contractors have employees,111CY must prol'ide theirworkers'comp.policy number. I out an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Harleysville Worcester Insurance Company Policy#or Self-ins.Lic.#:201600 6620967 10/1/2017 Expiration Date: '' t r, Job Site Address:O `� S cAt.M Z City/State/Zip:Nta�k Kr, DVL Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal viDlation punishable by 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 S250.00 a . day against thQvir.A op ofthis statement maybe forwarded tothe Office of Investigations of the DIA for insurance coverage veri1 do hereby cr the ins and penalties of perjury that the information provided above is true and correct. Sienature: Date: / Phone#:610-874-5000 ext 2509 Official use only. Do not write in this area,to be completed by cily or town official. City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 4: POWERCL-01 ELISEL ACORN" CERTIFICATE OF LIABILITY INSURANCE FD 09128/2016 Y) 09/28/2016 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 NAME: Lacher&Associates Ins Agy Inc. PHONE 215 723-4378 FAX (215)723-8604 Lacher Insurance Group,LLC (Ac, ( ) A/c No 632 East Broad Street F-MAIL Souderton;PA 18964 ADDRESS:Iacher@lacherinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# L ERA:Harleysville Preferred Ins.Co 35696 INSURED ER a:Harleysville Worcester Ins Co 26182 Power Home Remodeling Group,LLC ER c:National Union Fire Insurance Company of Pittsburgh 19445 2501 Seaport Drive,Suite 8110 ERD:Pennsylvania Manufacturers 12262 Chester,PA 19013ER 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 AD13L SUBR OLICY EFFICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE FXI OCCUR MPA00000089793N 10/01/2016 10/01/2017pREM sES E�aoc�cu occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO- JECT F-_1 LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ac Ift t $ 1,000,000 B X ANY AUTO BA00000089796N 10/01/2016 10/01/2017 SObILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ) HIREDAUTOS NON-OWNEDPROPERTYDAMAGE $ AUTOS Pat accIdont X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE BE 067941520 10/01/2016 10/01/2017 AGGREGATE $ 5,000,000 X DED RETENTION$ 10,000 $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY YIN X I STAtUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE 201600 6620967 10/01/2016 10/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Mass Auto BA00000018227P 10/01/2016 10/01/2017 Auto Liab 1,000,000 B NY Auto BA00000074849R 10/01/2016 10/01/2017 Auto Liability 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional ReMarkg StNaduld,may be attached If more apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of North Andover C 1600 Osgood St North Andover MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I I ' ,'f� r•srar rr�sict:%i1� s.Y�{rra, r�.F.ae P�.... .... ....... ' [lire nf(`unsrFuvrr,+15'nrrrLicense or registration valid for individul use only ' % Cat1t'iE tMPtCVt hENT.COhITRtiCTOt.R: before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation {2egistrdtion 188616 T € Yp 10I'�r,`Plaza-Suite Sl7p I Expiration: '3118l2(3YT. Su PP emen, :ard Bosh n,At Lib POWER HOME REMODELING GROUP LLC. j 1 MARK 1,90RDINI 2501 SEAPORT DRIVE STE 8110 CHE$TcR,PA 19013 - t ndcrrrrrtrir ' t valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards i License:CS-057645 Construction Supervisor MARK E MORDiNIx= 18 NEWELL DR " N ATTLEBORO{ytt1A 0fi0 E 4 Expiration: Gcsntl3ssroner 0811812017 i i