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Home My WebLink AboutBuilding Permit #790-16 - 11 CAMDEN STREET 1/7/2016 �AORTH BUILDING PERMIT \'fr, -a- _.""X6 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit No#J1 CHUS Date Issued: IMP Applicant must complete all items on this page 7- -",4 n-t- 77". A 9-5 OWN E 7 � 6 " — .........e. s, -o P V � rNI Q WI tstorii District n g IMNa a Fhiie Shop Village Yes no TYPE OF IMPROVEMENT PROPOSED USE JResidential Non- Residential El New Building El )ne family El Addition El Two or more family [I Industrial [I Alteration No. of units: Ei Commercial El Repair, replacement El Assessory Bldg AK Others: [I Demolition El Other Tyl 5 Pd'V —A rNr ,- ' -- M - ' Waersh Or fSeptic� S - Xet1bNds atro WFloodplain:MDESCRIPTION OF WORK TO BE PERFORMED: IN j- n r'OA . .. -Q F C --I- Y� . - . rnfLil4�ilOtA_ 7�0 9^ Identification- Please Type or Print Clearly OWNER: Name: L,Ge eke, LAA'(Je5 Phone: Address: -57— yy Contractor Ilk -A-va , e % '50WRI Date: I-Nx.n Supervisor's -41A. A4q, I i",en 4�' 55 s Home h�- 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: $ -3300-0 0 FEE: Check No.: Receipt No.: 6->41 NOTE: Persons contracting *h unregistered contractors do not Izave access to the guaranty fund ----------------- aMTLUC ,e.6f j Si nature - W. Location No. Q Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ �+Ar��:��` TOTAL $ Check# Cl_f s U r Building Inspector Location No. U Date ' • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ s a: Building/Frame Permit Fee $ r. -� Foundation Permit Fee Other Permit Fee UI`xv TOTAL $ Check# .� ' Building Inspector {.i T Plans Submitted ElPlans Waived.❑ Certified Plot Plan ❑ Stamped Plans El TypF 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 t 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®unpsteon�s to yes ,4Locatedat 124IMairStreet 4 5 _ -- ireDepartmen�ts�:gnature/date M r:� 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 s Doc.Building Pennit 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 o Building Permit Application o Workers Comp Affidavit ❑ 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 II NOTE: All dumpster er ermits require sign off from Fire Departmentprior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses L3 Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li 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 o 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) o Copy of Contract Li Mass check Energy Compliance Report o 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 � NORTIt� Town of _ Andover O *" 0 No. gb- 2-Al �, h ver, Mass 4 o LAN! 1 COC NIC Nl WICK ��S R�TEO PP C) - U BOARD OF HEALTH Food/Kitchen PERMI T I LD Septic System �- THIS CERTIFIES THAT ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, .................... BUILDING INSPECTOR ................ .. ................... Foundation has permission to erect .......................... buildings on .... . ......: . .. .................... wr� Rough tobe occupied as ....................... ....�.. .. ...A....... .... . ..................�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 Rough VIOLATION of the Zoning or Buil-ding Regulations Voids this Permit. Final PERMIT EXPIRES INAMON TY S ELECTRICAL INSPECTOR UNLESS CONSTRUCT- I N S 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. 1-7 Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8106 MSE MA Contractor Registration No 120979 A division of Thieisch[Engineering ENGINEERING' 60 Shawmul Unit 112,Canton.MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS RISE CMA-HES ENGINEERING THT IS E E CUSOTOMER FOR YINTO ORK AS DESCRIBED BELOW CUSTOMER L++�"^-�`'��^+•/n PHONE DATE CLIENT0 WORK ORDER Rebecca Wildes z Oyu (978)258-1998 10/30/2015 424670 00002 SERVICE STREET .c BRLNG STREET 11 Camden Street t 1 l Camden Street SERVICE CITY.STATE,ZIP BILUUG CITY.STATE,ZIP North Andover,MA 018 j North Andover,MA 01845 t JOB DESCRIPTION BARRIER:A Blower Door Test ill not b ttctxd"1(your home,due to the presense of asbestos. $0.00 BARRIER:Wc have identified a moisture issue in your home that needs to be addressed.Homeowner is responsible for correcting this moisture concern,prior to the installation of any weatheriralion work. $0.00 BARRIER:We have discovered what appears to be a mold/mildew-like substance in your home.This is being brought to your attention to identify it as a pre-existing condition to the insulation and air scaling work planned for your home.Your signature is your acknowledgement ofthese conditions and agreement to proceed. $0.00 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 he left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(6)working hours.A reduction in cubic feet per minute(cfm)ofair infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the wcatherization work,and at no additional cost to Ute 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. $510.00 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-35 Class i Cellulose added to(288)square feet of open attic space. $423.36 ATTIC FLAT:Provide labor and materials to install a 14"layer of R-49 Class 1 Cellulose added to(144)square feet ofopen attic space. $243.36 ATTIC ACCESS:Provide labor and materials to insulate the back of(2)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $120.00 VENTILATION:Provide labor and materials to install(2)12"X 12"aluminum gable end attic vent. $228.00 VENTILATION:Provide labor and materials to install(3)8"diameter roof vent(s)to increase ventilation in attic areas. The vent can be supplied in(circle color)black.brown,gray or mill finish. $256.50 VENTILATION:Provide labor and materials to install ventilation chutes in(24)rafter bays to maintain air flow. 548.00 BASEMENT CEILING:Provide labor and materials to install(98)linear feet of R-19 unlaced fiberglass insulation to the perimeter ofthe basement ceiling at the house sill. $171.50 Federal IQ#054405629 RISE Engineering RI Contractor Registration No 8186 RISE �A Contractor Registration No 120879 A division ofThielsch Engineering ENGINEERING 60 Shawmut Unit#2.Canton.MA 02021 CONTRACT ONTR w CT 339-502-335 FAX 339.502-6345 IV i Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RBE CMA-HES ENWNEEIIOAND THE CUSTOMER FOR WORK AS DESCRBEDBELOW CUSTOVER PHONE DATE CUMITS WDRKORDER Rebecca Wildes (978)258-1998 10/30/2015 424670 00002 Bla M STREET -- -- BALM STREET ---- 11 Camden Street 1 I Camden Street SERVICE CITY,STATE.EP SaAAM CITY,STATE,IIP - - North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION CRAWLSPACE:Provide labor and materials to install(144)square fect of R-19 unfitced fibcrglass insulation to the crawlspace ceiling to be in contact with the subfloor and completely filling the joist cavity to be flush with the joist bottoms. Then install I" polyisocyanurate foam board insulation. Seal all scams with FSK tape. $554.40 CRAWLSPACE:Provide labor and materials to install(428)square feet of 6 ml polyethylene over open ground in designated crawlspscclearthen basement areas. $329.56 CRAWLSPACE:Provide labor and materiels to install (90)square feet of R-10 rigid Thermax insulation to the crawlspace perimeter wall up to the sill and against the band joist. $333.00 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$2,000 per calendar year,and an incentive of 1001%for the Air Scaling 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 wealherization 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 weatheuization incentive is$3,110. $90.00 Total: $3,307.68 Program Incentive: $2,600.00 Customer Total: $707.68 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPC-gFICATION&FOR THE SUM OF "'=Seven Hundred Seven&681100 Dollars $707.68 UPON FUM INSPECTION AND APPROVAL BY RISE ENOCMER20- CM AGREES TO REDTAMOUNT DUE IN FULL.WrEREST OP I%WILL BE CHARGED MON MY ON ANY LOMAID BALANCE 30 DAY-SEE REYEBE FOR AMORT THIN ON OUARANTeEs,RIGHTS OP RECBION.SCNEDIIAQ AHD CONTRACTOR REGISTRATION. 00 SIGN THIS CONTRACT IF THERE ARE ANY13LANK SPA BIONATURE-RBE --- E NOTA THIS CONTRACT MAY BE WnHDRAWN BY LB IP NOT E%ECUIED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICM SPECS•TC=NS AND COMMONS ME 30 Days 81►TtsFACTORY TO NB AND ARE xERESY ACCEPrEo You ARE wiMoa®To oo THEWDAIL AS SPECIFIED.PAYMENT Wal BE MADE m OUnRIEDABOVE 4 OWNER AUTHORIZATION FORM (0mvs e) owner of the property located at l l Cri rol c/g- j, s. (Pmpedy Address) (Pmperty Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a budd'mg permit and to perform work on my property. ' I '� `i�,�;f'' it (� • l l Owner's Signature M Date The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Stree4 Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit:Bm7ders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUfHORM. Applicant Information ` Please Print Legibly Name(Business/Organization/lndividuap: Address: I)- C 8,r,� x City/State zip: v.-t F M lOPhone#: 64X-- `..S 1 S— Are you an employer?Cbeck the appropriate box: Type Of project(required): 1.alr1 am a employer with _aaployors(fun and/or part-4ime).• 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.ins ranee required-]m 301 aa homeowner doing all work myself:(No wotkers'comp_insurance cop rirod.)t 9. ❑Demolition 4.n 1 tum a homeowner and will be hiring contractors to conduct all work on my property_ 1 will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sok: I I.Q Electrical repairs or additions Proprietors with no cmpbyces. 12_❑Plumbing repairs or additions 5�l am a general contractor and I have biied the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers compinsurance-1 13.[:]Roof repairs 6_0 We are a corporation and its offices have exercised their right of acception per MGL G 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required) 'Any applicant that checks box q I must also 611 out the section below showing their workers'compensation polity information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suclL 1Contractors that check this box must attached an additional shoes showing the name of the sub-contractors.aod sate whctho or not those entities have employees. If the ab-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees: Below is the policy and job site information. V' Insurance Company Name: 0 Policy#or Self-ins.Lic.#: (�yJG r�.d ?, D' Expiration Date: FJ/ 201 Job Site Address: CA 1M. t-- City/Statc0p: n�d t/-((� 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 violation punishable by a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a Jay against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance ;overage verification. do hereby certify under the pains and pennaldes of perjury drat the information provided above is true and correct signature: �t; ►�� -'S�� A ''` - T --- Date: 'hone#: Gr k' J91 Off ficial use only. Do not write in dais area,to be completed by city or town of miaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5-'Plumbing Inspector 6-Other Contact Person. Phone fl: �..1 POLABEA-01 JONEILL ,d►��RO CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 1/6/2016 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). CONTACT PRODUCER NAME: _ Durso&Jankowski Insurance Agency PHONE 978 688-7000 Fac N 978)688-7001 11 Saunders Street AIC,No.-Ext). ) ( - -�i:( - E-MAIL North Andover,MA 01845 ADDRESS. __ T INSURER(S)AFFORDING COVERAGE _- I NAIC S INSURER A:Nautilus Insurance Co. 17370 INSURED INSURER 8:Safety- Insurance Company 33618 Polar Bear Insulation Co.Inc. INSURER C: Peter Leblanc&Steven Leblanc INSURER D: P O Box 958 — -- Andover,MA 01810 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 1 ADDL SU�BR J POLICY EFF POLICY EXP LIMITS LTR I TYPE OF INSURANCE I I D t - POLICY NUMBER MMIDD MMID� A X I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE I$ 1,000,000 i CLAIMS-MADEa OCCUR ( INN538691 03/24/2015 03/24/2016 OAMAGETO-REN apREMISEs(Ea oceuirence I.$ _ 50,000 —' MED EXP(Any one person) _ $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _I$ 2,000,000 X POLICY F—]PRO LOC PRODUCTS-COMP/OP AGG $ 11000,000 JECT — Is OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I$ 1,000,000 _(Ea accident) B II��ANY AUTO � 2100926 01/04/2016 01/04/2017 BODILY INJURY(Per person) $ ALL OWNED XSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ If - -._.. X �HIRED AUTOS X I AUTOS ,LPer accident-___ $ I UMBRELLA LIAB XI OCCUR I EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MAD AN019284 03/24/2015 03/24/2016 AGGREGATE $ DED 1 RETENTION$ II I I _ $ I WORKERS COMPENSATION i PER ERH _ AND EMPLOYERS'LIABILITY STATUTE Y/N! I � �----- ANY PROPRIETORIPARTNERIEXECUTIVE I E.L.EACH ACCIDENT _ $ OFFICERIMEMBER EXCLUDED? �I NIA (Mandatory In NH) III E.L.DISEASE-EA EMPLOYEE $ ff yes,describe under I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Insulation Work-Mineral Insulation Work-Mineral;Additional insured for general liability per blanket additional insured endorsement with respects to work performed on their behalf by the above insured is Thielsch Engineering CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thielsch Engineering Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE it /r1 4000 On-4e Amon/+AOO/IOA"f%kl All....1.�................+ 1/4/2016 Preview:Certificates of Insurance ACC o® CERTIFICATE OF LIABILITY INSURANCE °ATE'MM`DD"YYY' 01/04/2016 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(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: Automatic Data Processing Insurance Agency,Inc- AIC.PHONE E Ext: 77: -C.No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC i+ INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 429703 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 REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR NIAY 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. LTR TYPE OF INSURANCE INS° NND POLICY NUMBER (MWOO YY) (MMIDDIYYYY)I LIMITS COMMERCIAL GENERAL LIABILITY Ei.CF:OCCURRENCE S CLAIMS-MADE r-1 OCCUR PRET:1iSES IEa ozurrencei S MED EXP(Any one person) S PERSONAL&ADV INJURY S GENL AGGREGAT E LIMIT APPLIES PER: GENERALAGGREGATE 5 POLICY❑JECT PRO- ❑LOC PRODUCTS-C0MR-'01'AGG S OTHER: S AUTOMOBILE LIABILITY L :1 N SI•UL L I S (Ea...dcnt{ ANY AUTO BODILY INJURY(PL:person) S ALL Oiam'ED SCHEDULED AUTOS AUTOS BODILY INJURY.Per acaden4 S NGN-OWNEDU : Y r.G S HIREDAUTOS AUTOS iPer a[cidrntl s UMBRELLA LIABOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS4:4AOE AGGREGATE S DED I I RETEN170NS S WORKERS COMPENSATION X It U H AND EMPLOYERS'LIABILITY STATUIE ER _ ANY PROPRIETOR+PARTNEREXECUTIVE YIN E.L.EACH ACCI DEN r 5 1,000,000 A OFFICER.33EMBER,CXCLUDED? ❑Y NIA N POWC772258 01/01/2016 01/01/2017 (Mandatory in NH) E.L.DISEASE-FA EMPLOYE- S 1,000,000 It ses.dtscnbe neer DESCRIPTION OF OPERATIONS bdma E.L.DISEASE-POLICY UNIr S 1,000,000 I -TI .1 1 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES(ACORD 101.Additional Remarks Schedule.may be attached U more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Theiisch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE AG 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ��s�gt118t1OII - _ ItQl Aff�s and p z of Pias-Surto 5170 10 parkO- Boston,�b'�s strati.°n ome PrBvem Contca °T 1 Rei t°a� _ `am Type-- DBA -Cry9 tABEAR lNSV�-p`Tl4N Co P� R Vint LeBlanc p _ _ _ __- __` nforcbange. AVER, MA 01810 _. _- `.:==Ue Address snd reL°tn �mPt� ❑Lust C1 AND _ p _ Address OP�A� u � oune i:71%erIT 0: :}31i�3ai=-Y �f?� _6f4;sl3JS � 8fG1 .^„?.i :Ct '1� -'e��:i?c�tZfla �s �J Ir 2: ♦. .. „u,truction Super-oNor Speciality�Rsa_CSSL-1064i? prMALEBLANC �LT 2EAST P pW Nit 0386 va�:��ianai