HomeMy WebLinkAboutBuilding Permit #424-14 - 11 SAUNDERS STREET 11/12/2013 f NORT#1 q
BUILDING PERMIT # ro��T(`�o 6'6�°
TOWN OF NORTH ANDOVER ° p
APPLICATION FOR PLAN EXAMINATION
Permit N0:3��y•,/v
Date Received
Date Issued: i , SACHU`��
IMPORTANT:Applicant must complete all items on this page
LOCATION /1 SS a2 5
Print
PROPERTY OWNER %��dy1�1�1$ AXE``
Print
MAP NO: 'PARCEL&V ZONING DISTRICT: Historic District yesCn
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑One family
❑Addition ❑Two or more family ❑ Industrial
�eration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
Aflpudd A)"6,4) ef
,�Z�'ROM
e Cz n9e, #.)e6d (Xily,- 6� Met A e4 C-AJ kg�,6 zmcwx -
Identification Please Type or Print Clearly)
OWNER: Name: T`JLt* , Phone: 97K`br�~�
Address:
CONTRACTOR Name: 4 7X Phone: 6q-
ut
Address:
Yd, Nu ►Q166h CrM 0h,- �. (1166
Supervisor's Construction License: Exp. Date-
LSO q37�3 6- 7~ ?-o)S
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.
Total Project Cost: $ ZZ C-06 , ff 6 FEE- $ 6�6y Q Q
Check No.: M L Receipt No.:_�
NOTE: Persons contracting with unregistered contractors do not have access to t re guaranty f nd
Signature of Agent/Owner 144 Signature of contractor
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: 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 0 Others:
❑ Demolition ❑ Other
0 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
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.
Total Project Cost: $ FEE: $ r_
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature^of Agent/Owner Signature of contraCtQr-,a, <,
Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
"TYPE_OF.SEWERAGEDiSPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ _ Swimming Pools ❑
Well IT. Tobacco.Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc.- ❑ - - .permanent Dumpster on
Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
.DATE REJECTED DATE.APPROVED
PLANNING &DEVELOPMENT ❑ ❑
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
I)PW Tow;! Engineer: Signature:
Located 384 Osgood Street
FIRE DIEPARTI�E Ternp Dumpster on site yes no
Located-at 124 Mair Street -
-Fire Depa—&-he►t,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
El Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The folEowing is`a list of the requi-red.forms to be filled out for the appropriate permit to be obtained.
Roofir�g, Siding, Interior Rehabilitation Permits
o
Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
u Copy of Contract
a Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster.permits require sign off from Fire-Department prior to issuance of Bldg Permit
Addition Or Decks
Li Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
Li Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a 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)
u Building Permit Application
o Certified Proposed Plot Plan
a Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm-tted with the building application
Doc: Doe.130ding Permit Revised 2012
Location
No. / 2 / / �G� Date
• • TOWN OF NORTH ANDOWER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
.r
G I' U Building Inspector
(reu 1106)
R 01-1
ER 1-4 ; SEC TION.'S 251F.26FI/2
GG. C.H A P
City r" 70'Afll
This ,2
Crzrdiles ut;lc-t the property iccz,ed et
I las equl'pped ltvft E.; Qc)
detLEctOr =Lidl car' n rnancA* de ajar,—,is
and wa�;fcl-ltldto be In ccnipliancWill
M2s-cSr-hU-9ett5 Cvner�J- Laltv, Cha 'ter` 143 Sedcris 26F,—261"m ar-ldF I
-�CIARSI'etseq.
Inspe-dor-il-eetfing cOmplete'd on: IQ 1' ..,1111
Fez.Pat
He;-=d of Fra Dep2rt-IjEnt
sictly p))daysEft-efda'-di issue,
SELLER'S capy
Location
No. Date 1012'11111
• - TOWN OF NORTH ANDOVER
• S�;fi' b rte` •
Certificate of Occupancy $ f
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# f
v s 1 J Building Inspector
'11�Ouno x..49
SSACR"S.
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 424-14 on 11/12/2013 Date: October 24, 2014
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 11 Saunders Street
MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER
REGULATIONS AS MAY APPLY.
Certificate Issued to: Thomas Angeli
11 Saunders Street
North Andover, MA 01845
61�
Building Inspector
Fee: $100.00
Receipt: 28175
Check :9264
r 1 NORTH -
O
No. _14 .
_
0 h ." ver, Mass,
coc NIc"t WICK
Ab
1.
7 V BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
t
THIS CERTIFIES THAT ' ` ' ' ° ' ' '' BUILDING INSPECTOR
............... . ... , ... ... .r. . ................................................................................
Foundation
has permission to erect .......................... buildings on-..:....;...'.: .:....`.. '.
.............................................
. 4 Rough
to be occupied as .f.. .::' . : :....................-'. .'.: :.....�.......%......:�:.:°� ..... °....x�� ........ '�F' '
.. ... .... ... :"'..:..��..::;. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application .nal ` /� �
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 IN ECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Y' _
Final ,
PERMIT-E)CPIRES IN 6 MONTHS ELECTRICALINSPECTOR
UNLESS CONSTRUCTION STARTS Rough-
/ Service
........„....... -;......t. .......................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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 74—
Street No.
IF Smoke Det.
SEE REVERSE SIDE
r 7 NORTH
wn ve' 'o
0
..,
No. 2oq.- 14 _
h , ver, Mass, = "
COC NIC Nl WICK y1'
X1,9 A°'4Areo ►P�,��y
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ...::.:.:... .. :t.'-.............................................................................. BUILDING INSPECTOR
Foundation
has permission to erect buildings on-....,.. ....:.:c.:
........................... ...... ... ...............................................
.y Rough
Chimne
to be occupied as .1.. :` .... ..................... L:i..::: :..:..................... . ..: ...... :.....:�` !.......... .:: y .
..:
provided that the person accepting this permit shall in every respect conform to the terms of the application
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 IN ECTOR
Rough
VIOLATION of the Zoning or Building Regulationt Voids this Permit.
Final ,
PERMIT-EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough-
.^ Service
...........ir.......y.9
y.::.m.:. :..r..,..:.. ............................... 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 Stc ,�-
Street No.
Smoke Det.
SEE REVERSE SIDE
r• , NORTH
- . : ver
No. 2q.- 14 4q4i
._, h , ver, Mass,
�,
o LAM& oj,
+� C0
C"Kt#2WICk V
r�p�RgTED PQp,`'�y .
aS V
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT .................:.: .....'::.:''z.a.'_.............................................................................. BUILDING INSPECTOR
..
has permission to erect ........buildings on Foundation
................... / .........._.'.::.`p....f. :'..c..................:.....................�....... Rough
{
to be occupied as .f.. ... ' ..:.....r. ..... ... .............................: ::...°...... r
Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
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 IN ECTOR
Rough v,>
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final ,
PERMIT•EPIRES IN 6 MONTHS ELECTRICALINSPECTOR
UNLESS CONSTRUCTION STARTS Rough_
�3
Service
....................v.::.el,::�1::/f..; ....R4................................
wFinal
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired 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 St6
Street No.
Smoke Det.
SEE REVERSE SIDE
Enter construction cost for fee cal- North Andover Fee Calculation
Construction Cost
$ 229000.00 m
$ - $ 264.00
Plumbing Fee $ 33.00
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 33.00
Total fees collected $ 430.00
11 Saunders Street
424-14 on 11/13/13
Remodel Kitchen and 2nd Floor Bath
Add new 1/2 bath
r 1 NoRr#I -
w: 2 _� C ver
No. 142q.- t -
'4
ver, Mass,
o �c �.
'QA COCNI "tMl WICK`y
�.9 �R'ATEO ►.PP�.�S
S u
BOARD OF HEALTH
Food/Kitchen
PERMIT T. LD Septic System
THIS CERTIFIES THAT ...........V..a IV7 Avy.8It. ........................................................................ BUILDING INSPECTOR
11.._5 ,�,K �s `54........................ Foundation
has permission to erect .......................... buildings on ........ ...... .. ...... .: .....................
�
coo/ Rough
to be occupied as ..... r�.�..6 �:.f..t e...1 !Y............ 4?��/t/�r�7. ...J/Ys � .f, � � 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 CONSTRUCTION STARTS 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.
SEE REVERSE SIDE Smoke Det.
T.lie Comm oil of 11lassachusetts
Department of Inchtstrial.Accidents
Office of Investigations
600 Washington Street
Boston, AYA 02111
Tvt-vw.mass.gov/dia
t•s' Cotn ensatiott Insurance Affida«t: Build erslCont.ractors/El Please Pi/v t Le ib1Y
nibers
�� of ke P
Applicant Information
Name (Business/0rg,iriization/lndividtial):
Address: b 3i'
Phone #:
Cit}'State/Zip:
Type of project(required):
Are.you an employer?Check the appropriate 2-f am a general contractor and I 6. []New construction
1.El am a employer with have hired the sub-contractors 7. remodeling
employees(full and/or part-time).* listed on the attached sheet. t .
2.❑ 1 am a sole proprietor or partner- These sub-contractors have
g. []Demolition
ship and Dave no employees workers' comp. insurance. 9. []Building addition
working forme in any capacity. 5 We are a corporation and its
(No workers' comp. insurance 10:❑Electrical repairs or additions
officers have exercised their
required.] right of exemption per MGL 11.❑Plumbing repairs or additions
3.❑ I am a homeowner doing all work c 152 §l(4)>and we have no 12.[]Roof repairs
myself. [No workers' comp. employees.[No workers' 13.[]Other
t
insurance required.] comp. insurance required.]
fill out the section below showing their workers'compensation mouse submit a n'e v affidavit indicating such.
*My applicant Uiat cubmi box
t#1 must alsocontractors
• 1 Homeo++mers+vho submit this affidavit indicating they
are doing all work and Dien hire outside
t ontreown that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.
h e p cyan d job site
C
1 am an eniplwer that is providing workers'compensation insurance for n�V employees. Below is policy
information.
Insurance Company Name: rn2r 2�r J _
`off� �/� Expiration Date: �7
Policy #or Self-ins.Lic. 4' !
Ciry/State/Zip:
Job Site Address:
the workers' compensation policy declaration page(showing the policy numof criminalipenalties'lof)a
et
Attach a copy ofGL C. 152 can imposition
Failure to secure coverage as required ands nmentnaSwell aof slc it penalties in the form of a STOP WO
fine
ORDER to the af d a fine
fine up to$1,500.00 and/or one-year imp
of up to$250.00 a day against the violators. Beadvised v anon copy of this statement maybe forwarded
Investigations of the DIA for insurance coverage
c e d penalties of pe,ju►•y that the information provided above is true and cpnect.
1 do hereby
Date:
Signature:
Phone #:
official use only. Do not write in this area, to be completed by city or town off Bial.
ff
Permit/License#
City or Town:
Issuing Authority(circle one):
• of Health 2. Building Department 3.City/I'own Clet•k 4. Ele.etrical Inspector i.Plumbing Inspector
1. Boat d
G. Other
Phone#:
Contact Person:
Information and ks' uctions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
T ursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be.deemed to be an employer."
MGL chapter.152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally-MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for,the performance of public_work until acceptable evidence of compliance with the"insurance
requirements of this chapter havebeen presented to the'contracting authority.?'
ty:".
- .
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your'situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners;are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit: The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
industrial Accidents. Should you have any questions regarding thelaw or if you are required to-obtain a workers'
compensation policy,please call the Department at the.number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate-line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at thebottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit%licensenumber which will be used as a reference number. In addition,an applicant
that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating curre
policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city
townj:"A copy of the-affidavit that has been officially stamped or marked by the city or town maybe provided to the
applicant as proof that a.valid affidavit-is on file for future-permits or licenses. Anew affidavit must be filled.out tact
Yen.Where a home-ownerorcitizen is obtaining a license or permit not related to-any business or commercial ventur
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The office of Investigations would like to thank you in advance for your cooperation and should you have any gaesti
please do not hesitate to give us a call..
The Department's address,telephonewand fax number:
The Commonwealth:of Massachusetts
Departtnerat of lndustcial Accidents
office of Investigations
600 Washington Street
Boston,MA 02111 ,
Tel, #617-727-4900 ext 406 or 1-877-MASSAFE
Revised 11-22-06 Fax#617-727-7749
vvww.mass.gov(dia
f � y
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1
9/26/2013
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. Astatement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CUNT
-NAMEAUI
M P ROBERTS INS AGCY INC A/C,,Na,End: (978) 683-8073 (A/C,N.):(978)683-3147
1060 Osgood Street ADDRESS:Paula@mprobertsinsurance.com
North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC9
INSURER A: AMERICAN EUROPEAN INS CO
INSURED ATA BUILDING & REMODELING, INC. INSURERS: MERCHANTS INSURANCE GROUP
42 TOWER HILL ROAD INSURER C:
NORTH READING, MA 01864 INSURER D: ASSOCIATED EMPLOYERS INS CO
978-664-3364 INSURER E:
CELL 978-621-1749 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
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000
CLAIMS-MADE CI OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Anyone person) $ 5 000
A SKP200020312 06/10/13 06/10/14 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑JE T CI LOC PRODUCTS-COMP/OPAGG $ 2 000 000
OTHER: $
AUTOMOBILE LIABILITY
Ea accident $ 500,000
ANYAUTO BODILY INJURY(Per person) $ !I
ALLOWNED SCHEDULED MCA7013039 03/10/13 03/10/14
AUTOS F-x
I AUTOS BODILY INJURY(Per accident) $
BNON-OWNED PROPERTY DAMAGEX HIRED AUTOS AUTOS (Per accident) $
UMBRELLA LIABOCCUR EACH OCCURRENCE $
EXCESS LIAB FI CLAIMS-MADE AGGREGATE $
DED I I RETENTION $ $
WORKERS COMPENSATION X -
Y/"
AND EMPLOYERS'LIABILITY STATUTE ER
ANY PROPRIETORIPARTNER/EXECUTIVE WCC5005009237012013A 05/21/13 05/21/14 N/A E.L.FACHACCIDENT $ 500,000
D OFF"ER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe aftachedif more space is required)
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1600 OSGOOD ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
0 1988-2013 ACORD CORPORATION.All rights reserved.
ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD
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tuac/
i•- Office of Consumer Affairs&BusinessRegulzt;l Board Of Building
!r OME IMPROVEMENT CONTRACTOR 9 Regulations and Standards
3 -registration: 173922 Tye C1)n.rrurrio)n Supenic��r
License: CS-043773
xpiration: 11126/2_014 Corporation`
ATA BUILDING& REMODEEING_' t THOMAS P ANGELI ---
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THOMAS ANGELI t t1
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