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HomeMy WebLinkAboutBuilding Permit #792-2017 - 11 LITTLE ROAD 2/24/2017 IAORTy BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " `� Permit No#: Date Received ArED,.Q4' Date Issue - EVIPORTANT Applicant must complete all items on this page r d LOCATION �=Gr Punt' C°�,x*f' -�`•�i, .a�" ry . � :t- ! y x5 .- ��'-..'' - •'I ,,Mv �r*,f� s�`{�"i+.�>' 4� PROPERTY ®WNER= * r '� Y - Pnnt "� ear' . tru urea; yes no (VIAP- M PARCEL ZONING'DISTRICT {:H�stor�c Distnct � eyes ro - ' Mach ne Sho Village eyes , 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 Wt i7.+P:24T-fO M v •^7 •. .6 .� ` _ 0 SbticeFV11e11 0 Floodplain Wet[ands` Watershed Disti ict . P 4• �.INatLWSewer{: — -- DESCRIPTION OF WORK TO BE PERFORMED: L/f H I _ Identification Please Type or Print Clearly OWNER: Name: 45;�f"c,:G ea ST Phone: x/570 Address: ;7-71'e r-d Peter Leblanc - Contractor Name: 2a*•e c. �. Supervisor-S`ConstructtoLivenS �• _.A Dat en rove: erit.License.... �P.:. . 5. /6 _ .yHo� e li7i f rn - _ ARCHITECT/ENGINEER Phone: : . Address: Reg. No. FEE SCHEDULE.B ULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. f. _,Total Project CoSt: $ �)6Od• PC) FEE: $ 30-Oa c Check No.: Receipt No. -1 8 NOTE: Persons contracting with unregi=stered contractors coo not Piave: es o the ga aranty fund 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 ❑ Workers Comp Affidavit o 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.1.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross SectionlElevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products VOTE: 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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products COTE: 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 Appeal 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 f Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ FP:ubhc,Sewer EWERAGE DISPOSAL ❑ , Switroming PoolsTanning/MassageBody Art Q- ❑ Tobacco Sales ❑ ackaginSale ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ . I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ I'i . COMMENTS � t j! CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature ` 1 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments h Conservation Decision: Comments s 3 Water & Sewer Connection/signature& Date Driveway Permit P DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT- -.Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: - r. ELECTRICAL: Movement of Meer 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) f - I ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Pennit Revised 2014 4 Location No. ��'� Date t . - TOWN OF NORTH ANDOVER � : �' �may, • Certificate of Occupancy $ Building/Frame Permit Fee $- r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r� { s y Check o I t') / ' Building fsKspeCtor � NORTIy � Town of Andover 0 Zb h ver, Mass �. 2qft2AII 0".0. 1. 1 A- COC NICNl WICK s u � BOARD OF HEALTH Food/Kitchen PER I D Septic System P THIS CERTIFIES THAT .....M� , ,,,, BUILDING INSPECTOR ...... ... ..... ..... .. ............. . c�..Le... /1•-� Foundation has permission to erect .......................... buildings on .:...I. .....��... ... ....... . �,.. ., to be occupied as .. .�',S,ie,s,�, ,,, ' Rough .... A � ... .. ..f.... ............ .�. . '!'l�.. Chimney provided that the person accepting this pernfit�hall in every respect con orm 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 CONST ION Rough Zwoo-- Service BUILDING .. . ..... ...........IN ECT... ....... .. Final, 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. e.. 0 L/ lJ / Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No R1 S E 60 Shawmut Road,Canton.MA �/� ENGINEERING CONTRACT 339-502-6335 FAX 339-5024345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE 'CMA-NES. ENGINEERING AND THE CUSTOMER FOR WORK AS .. . ._�.+ - DESCRIBED BELOW CUSTOMER l `� {�+. PHONE DATE CLIENTS WORK ORDER Craig Decosta C" j,. (508)450-5133 02/02/2017 439570 35004 SERVICE STREET -'' 1.. BILLING STREET 1.1 Little Road {`� t_., 11 Little Road SERVICE CM,STATE,ZIP j C� t •, BILLING CITY,STATE,ZIP' North Andover,MA 01845 North Andover,MA 01.845 SOB;DESCRIPTION AIR SEALING:Provide labor and materials to seat areas of your home against wasteful;excess air leakage. This work will be performed 5595.00 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 home can include caulks,.foams and other products. Primary areas for sealing include air leakage to attim basements,attached garages and other unheated areas(windows are notgenerally addressed.) This will require(7)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 thehomeo%vncr,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. AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and adoorsweep to(2):door(s)to restrict air leakage. $160.00 DAMMING:Provide labor and.materials to install a 12"layer of R-38 unfaced fiberglass baits to(28)square feet for damming purposes. 557.40 AT 11C FLAT:Provide labor and materials to install an 8 layer of R-28 Class I Cellulose added to(610)square feet of open attic space. 5835.70 i VENTILATION:Provide labor and materials to install(1)insulated exhaust hose to existing bathroom fin(s). 550.00 I COM MON WALLS:Provide labor and materials to install blown in Class I Cellulose to(90)square feet of 4"common wall through an S148.00 interior surface drill and plug method. Plugs will be spackled:and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will.be the customet's responsibility.Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the:wealhcrization work to be performed.'Your signature is youiacknowedgement of receipt and agreement to proceed. STAIRWELL:Provide labor and materials.to install Class l Cellulose insulation to the shectrock or plaster ceiling and/or walls of a $175.00 stairwell which are common to heated space.through A surface drill and plug method. The holes are`plugged.with styrofoam plugs.and spackled to a rough finish. Any sanding and painting required arc the customers responsibility. Homeowner has received a copy of the EPA's Renovate Right Lcad-Safe infbanation guide explaining the potential risk of the lead hazard exposure from the weatheri7ation work to be performed.Your signature is your aeknowedgcment of receipt and agreement to proceed. BASEMENT CEILING:Provide labor and materials to install(89)lincar feet of R-19 unlaced fiberglass insulation to the perimeter of 5155.75 i the basement ceiling at the house sill. GARAGE CEILING:Provide labor and materials to install 0"R-35 densely packed Class I Cellulose insulation to 162 square feet of 5335.34 garage ceiling located below a heated floor area,by drilling holes in Ute ceiling from below. Holes drilled will be plugged. Plugs will be sparkled and left in a relatively smooth condition.Finish sanding and touch-up primingfpainting hill be the customer's responsibility. Federal 10#05-0405629 RISE Engineering Rl Contractor Registration No 8186 MA Contractor Registration No 120979 V CT Contractor Registration No RISE 60 5huwmut,ttoad,Canton,N11 p/� ENGINEERING` CONTRACT 339:502-6335 FAX 339-503=6345- Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUE NT4 WORK ORDER Craig Decosta. (508)450-5.133 02/02/2017 439570 35004 SERVICE STREET BILLING STREET 1 I Little Road I1 Little Road SERVICES CITY.STATE.ZIP BILUNO CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB'DESCRIPTION RISE Engineering Evill apply all'applicable.eligible incentives to this contract. You will only.be billed the Net amount: Currently;for $90.00 eligible measures.Columbia Gas offers 75%incentive,not to exceed$2.000 per calendar year,and an incentive of 100%for the Air Scaling measures up to the first 5680 and an additional 5340 if savings-arejustified by the auditor: Forthe safety and health of your home's indoorair quality,wewil)be conducting a blower door diagnostic Of the available air flow in your home both before the work is begun,and after the weatherintion work is complete.We-MMI 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 toyou. Total allowable weatherization incentive is$3;110. Total: $2,602.19 Program Incentive: $2,031.64 Customer Total: $570.55 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN.ACCORDANCE WRH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Seventy 8155/1.00 Dollars $570.55 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILLBE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMAnoN ON GUARANTEES,RIGHTS OF RECISION;SCHEDULING,AND CONTRACTOR REGISTRATION. E-SIGNED by Nathan Weiss E-SIGNED by Craig Decosta AUTHORIZED SIGNATURE•RISE EnpineoNng CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DALE OF ACCEPTANCE February 02, 2017 ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE DAYS, SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WALL BE MADE AS OUTLINED ABOVE it RISEN60 Shawmut Road,.Lin it 2,j canton,MA 020211339-602-6335 . ENGINEERING www•RISE.engineering.com Efficiency Energized. OWNER AUTHORIZATION FORM Craig Decosta (.Owner's Name) owner of the propertylocated at: 11 Little Road (Property Address) North Andover, MA 01845 1PmnArtu Aridraccl 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. This form is only valid with a signed contract.. E-SIGNED by Craig Decosta Owner's Signature February 02, 2017 Date I N .W. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly INSULATIONPOLAR BEAR Name(Business/Organization/Individual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone#: 57 Are you an employer?Check the appropriate box: Type of project(required): 1.N I am a employer with 1�7 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers9. ❑Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-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. Insurance Company Name: VIA k v r C t P Y � P4 0�� � S f�W nN� tr,/ Policy#or Self-ins.Lic.#: Pow, P\f 8 3 to/ Expiration Date: at • he i? Job Site Address: L 1�ft I:! City/State/Zip: ,4 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 frte 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 paiM andpenalties ofperjury that the information provided above is true and correct Simature: Date: 3/ / Phone#: �I��'" y p�. 763 p Official use only. Do not write in this area,to be completed by city 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1/3/2017 Insurance Services ago CERTIFICATE OF LIABILITY INSURANCE °"TE'M""°°"""' 01103!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(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 endorsemengs). PRODUCER CONTACT NAME: PHO Automatic Data Processing Insurance Agency,Inc. (AIQ No.Ext): A1C,No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD Insuranoe Company 31470 INSURED INSURER B POLAR BEAR INSULATION CO INC INSURERC: PO BOX 958 Andover,MA 01810 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 598370 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 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 LTR TYPE OF INSURANCE FWULW1NSD W IS POLICY NUMBER OLIO YEFF OLIO Y P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S MED EXP(Any one person) S PERSONAL 6 ADV INJURY S GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F-1JEOT- LOC PRODUCTS-COMPiOP AGG S OTHER: S AUTOMOBILE LIABILITY WM8I dent! _ S ANY AUTO BODILY INJURY(Per person)ALL S AUTOS Autos nuto �DULEO BODILY INJURY(Per accident) S HIRED AUTOS AUTOS - S (Per accident 5 UMBRELLALIABEOCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-MADE AGGREGATE s DED RETENTIONS $ WORKERS COMPENSATION X I ER AND EMPLOYERS'LIABILITY STATU YIN TE ER ANY PROPRIETOMPARTNERIEXECUTR E E.L.EACH ACCIDENT S 1,000,000 A OFFICERIMEMBEREXCLUDED? Y❑NIA N POWC840361 011011201.7 01101/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 11000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Contractor License:CSL 106017 HIC 102726 I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main st North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I https:lladpia.adp.com/ISExtemal/app/index.html?clientid=2037315&requestFrom=run#lhome 1/1 AC EP CERTIFICATE OF LIABILITY INSURANCE FDA(MM/DD/YYYY) /10/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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 polloy(ies)must be endorsed, if SUBROGATION IS WANED,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 andorsemen s. PRODUCER NAWCT Linda Bogdanowicz Insurance Solutions Corporation PHONE (6O3)3H2-4600 (AMFAX N :(603)382-2034 60 Westville Rd -Mall ADDRESS:lindabEisc-insurance.cam INSURER AFFORDING COVERAGE NAIC 0 Plaistow NB 03865 INSURER A Hestern World INSURED INSURERs:Hautilus Insurance Group Polar Bear Insulation Company Inc INSURER C: PO Box 958 INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1632326134 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 I TYPE OF INSURANCE D POLICY EFF POLICY D� L POLICY NUMBER Y MMIDG+YYY UMnS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ACLAIMS-MADE a OCCUR DAMAGE TO RENTED PREMISES Eaoccurrence) S 100,000 NPP8274967 3/24/2016 3/24/2017 MED EXP(Any one n) 5,000 -PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 S POLICY❑JECT PRO- �LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ aceid nt ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED SCT�ULED BODILY INJURY(Per aceiderq S NON-OWNED PROPERTY DAMAGE HIRED AUTOS Peraccid $ S R UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000 B EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEO RETENTIONS M026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION I PERTU AND EMPLOYERS'LIABILITY YIN ATUTE ER ANY PROPRIETOR/PARTNERIE(ECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In Nth E.L.DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, H& 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SJA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD frame and logo are registered marks of ACORD INS025 oni4mi Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Nome Improvement Contractor Registration Registration: 102726 - Type. DBA Expiration: 7/212018. Trap 419291 POLAR BEAR INSULAT[ON CO. Vincent LeBlanc P.O. BOX 958 _ ANDOVER, MA 01810 Update Address and return card.Mark reason for change. SCA 1 a 201A-05lit E]Address E]Renewal [] Employment Q Lost Card Jac�••r�i�nnnntvifla<a�t'�flac;rt�r�sclLi Ofllee or Consi erAtlai s&Badness Regulation lAcense or registration valid for individual use only T HOME IMPROVEMENT CONTRACTOR before the empiration date. Hfound return to: Registration: 102726 Type: Office of Consumer Affairs and Business Regulation P Expiration: 7/2!2018 DBA 10 Park Plaza—Suite 5190 Roston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST.45A. LAWRENCE,MA 0181 Undersecretary' Not valid without sigaatore S .4- �cSSc:Ct?ii5 •:S-.�i3?c',:i,tE^:�C � 3.''';L.�a`c'2i;1 Board 0- )nC11ng Regula ions lld SI-a dards CSSLA06017 k PETERA LEBLANFC _ 2 EASTPM STREET- Plaistow NH 03965 On az rsss<cr,er 04/28/2018 0