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HomeMy WebLinkAboutBuilding Permit #590-2017 - 11 WALKER ROAD 12/2/2016 NORTH BUILDING PERMIT 6 w- b•r0 NORTH ANDOVER TOWN OF NO o ON FOR PLAN EXAMINATION APPLICATION Ac - XT n O Oi� y. Permit No#: i� Date Received ��AORITED US �SSACHus��. Date Issued: ORTANT:A licant mrust complete all items on this page �J LOCATION � Prin PROPERTY OWNER NOS" Sfe�,J�f, t Print 100 Year Structure yesOno MAP PARCEL: ZONING DISTRICT: Historic District yes 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 epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑:-Septic D1Nel) ` ❑ Floodplain 01Netlands WatershedDistnct'; DESCRIPTION OF WORK TO BE PERFORMED: Identification J PieTseType or Print Clearly 7 • OWNER: Name:_J�,Jc,f Phone: Address: f E �� ��.Q✓- Contractor Name: 12 ob er� u Phone: qD�r Email: Address: hd,e-0 S UA 0 Supervisor's Construction License: 0 g �° tj �(� Exp. Date: Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.'$12.00 PER$9000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ,'f'_ FEE: $ l Check No.: HAI ___Receipt No.: NOTE: Pe s ns conteing -dtlz tm egistered contractors do not have access to the guaranty fund ;: oSignature:`' . C, 1 %40 R Ty BUILDING PERMIT 0* 1-Fo TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION '' A Z 4 Permit No#: Date Received Zoo �SSgcHus���5 Date Issued: IMPORTANT:Applicant must complete all items on this page ?PROPW Y1-WKIN, - " �Pnnt 100YearSfuctu' re dyes ono .MAP . r PARCEL w __ ON _T, �Histonc#Distncta e..s� in `MachirieShop°Uillage' 'Yes; tinof TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition ❑Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other wO;Septic, .Well' - i ❑ Floodplain 0 Wetlands �� '•_- WaterShedDisfnct ;�Water/Sewer„.• • • �- .r c DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: ContractorENamePhone- _. ._ .� -,, __. _. _ .._ Adtlress= _ s v F }�Supervisor1s1Constru thio-N'License HomeliYiprovementLicense _ _� ,Exp - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No,; NOTE: Persons contracting wk? nregistered contractors do not have:access to the guaranty fund Signature of Agent/Owner Signature of contractor_; o , Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ IYPE'bF 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 i COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no ,. . ._ Located.,at•124.Main Street Fire:Departrrientsignature/date, COMMENT n I limension 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) Ll Notified i Call Email for pickup p ate Time Contact Name Doc.Building Permit Revised 2014 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Ener Compliance mpllance 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 o 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 o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 Location I k,,AJ(VA -Y- No. �"_2 C' I Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ �S Building/Frame Permit Fee $ -r Foundation Permit Fee $ % Other Permit Fee $ TOTAL f $ I Check# l' ,-t ,-j n Building Inspector F pe� NORT�y° own o ndover . 0 No. h ver, Mass, CP ' C)A COCNI(Nl WICK .1,V R�TEO ►`PP,`'�5 7 V BOARD OF HEALTH Food/Kitchen PER I D Septic System THIS CERTIFIES THAT . . ,{/ BUILDING INSPECTOR .....mm........... . ......... -.... .v . ............... . Foundation has permission to erect ........ .............. buildings on Al.....W. ...li.' ............. ............ ..... ........ Rough to be occupied as ......... ......... .�� �1�. �. .�. .. Chimney provided that the person accepting t is 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 1 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT TART 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. i I AT-HOME Job#_9676842_ To whom it may concern, I Re: address: 11 Walker Rd#6 North Andover Ma 01845 Concerning the above location,We give the Home Depot approval to install Number of windows_4 Style ( Double Hung/Casement, name type) DH Color White Manufacturer Andersen American Craftsman Exterior finish as agreed to be PVC(wrap trim)? Yes color White We agree to the grid or lack of grid configuration Y 8/8 Are grids between the panes of glass? Y As stated these proposed windows do meet with the Condo Management approval and will match exact) what' y to s there e e now. I Name: 5i(4lyle;c/ Title: Date: i/ /G / I i Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 Salesperson Name and Registration Number: Leonard Racite : R-1-073-14-00023 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Mark Stewart Boston North 9676842 First Name Last Name Branch Name Lead# 11 Walker Rd #6 NORTH ANDOVER MA 01845 Customer Address City State Zip (978) 973-1361 Home Phone# Work Phone# Cell Phone# markstewart2153@yahoo.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address city State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANPLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN-ORAL AND Pdagio'476b, . N NOTICE YO RIGHT TO CANCEL. Acknow, X 11/09/2016 Customer'srure _ Date 1 Distribution: White-Home Depot Yellow-Customer Copy Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless a different payment schedule is specified in the State Supplement. 5631.00 Includes all applicable discounts, rebates, and , taxes. Contract Price $ Excludes finance charges.* Minimum %deposit$ Due Immediately Remaining balance $ Due upon completion Finance Charges *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will ❑will not -1 be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of Windows A more detailed description of the work to be performed is included in the section entitled Scope of Work which appears on page 3 of this Agreement. Anticipated Delivery Date / Installation Schedule Approximate Start Date: 01/04/2017 Approximate Finish Date: 02/01/2017 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address,withdraw your consent, or obtain a paper copy of the Agreement or related documents ato charge. By providing your consent and verifying your email address above, you confirm that you ha access to a computer that can receive and open emails and PDF documents. B i it' °ing this paragraph, I consent to receive only electronic records related to this transaction. V TT-1 Initial cce t ce and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or(b)order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, acknowled a you have read, understand, and accept this Agreement in its entirety, including e eII.Te; s nditions and State Supplement, if any. You further acknowledge receivi a c m dco this A�gement. Keep it to protect your legal rights. X 11/09/2016 Customer's Signature Date X Cosigner(if applicable) DateI X 11/09/2016 Sales Consultant's Signature Date 2 Distribution: White- Home Depot Yellow-Customer Copy V j License number(s) held by or on behalf of the Home Depot: MA Home Improvement Contractor Reg. # 126893 License numbers are subject to change in accordance with local or state government processes. For the most current listing of license numbers held by or on behalf of the Home Depot, please visit www.homedepot.com/ licensenumbers. Scope of Work Job#: (internal Reference) Products: Spec Sheet(s)#: Project Amount ❑ Roofing ❑ Siding , Windows Insulation 9676842 ❑ Gutters/Covers ❑ Entry Doors ❑�_� 9676842 $5631.00 ❑ Roofing ❑ Siding ❑ Windows ❑ Insulation ❑ Gutters/Covers ❑ Entry Doors ❑0 $ ❑ Roofing Siding Windows Insulation $ ❑ Gutters/Covers ❑ Entry Doors ❑0 ❑ Roofing ❑ Siding ❑ Windows ❑ Insulation ❑ Gutters/Covers ❑ Entry Doors ❑ $ SubTotal $5631.00 Sales Tax $0.00 Total Contract $5631.00 Amount Warranty: The warranty on the work identified above is listed in the General Terms and Conditions, or if applicable, specified in the following documents: VantagePointe 6500-6100-6060 Warranty , VantagePointe 6500-6100-6060 Warranty Warranty , VantagePointe 6500-6100-6060 Warranty , VantagePointe Name(s): 6500-6100-6060 Warranty 3 Distribution: White- Home Depot Yellow-Customer Copy AT-HOME Job#_9676842_ To whom it may concern, Re: address: 11 Walker Rd#6 North Andover Ma 01845 Concerning the above location,We give the Home Depot approval to install Number of windows 4 Style ( Double Hung/Casement,name type) DH Color White Manufacturer Andersen American Craftsman Exterior finish as agreed to be PVC(wrap trim)? Yes color White We agree to the grid or lack of grid configuration Y 8/8 Are grids between the panes of glass? Y As stated these proposed windows do meet with the Condo Management approval and will match exactly to what's there now. Name: ��¢/'y S�ilitii�;c� Title: E Si Date: TT i S ron tart .xqn vN;3 1-•J^1 ,1�'-�. JIuss rgcr rr t,:�.� ice..._ --" r • .�Gi yi..illy Ino" V i ily.,� 1 ( i'J�lil 3.rg f. _.`;./_� S- si=J?51rac't�sCinaG of r'llli33 - ----` i DH CPD.S3P-A-44-21042-00002 ENERGY PERFORMANCE RATINGS EVALUACION DE RENOINIIENTO ENERGETICO U^3�ryf Saiar Heat Gain OaeTe'ent 0.29 1 .65 0,24 ADDITIONAL PERFORMADNCRE DRATIN�GS E lALU o a Yiisible Transmittince 0.45 1 , i�s 7.31:xe-a a.,drift:. 31;":,3u. - .,:_" ,o... .-:.}Y•:1_ f:^:r S'i(7,,.=...i 3�3(i 7.i .�.:'-_i.•..... 1 f.lel ' � ..a_ .,._L,T.,..._... ,;....•. ,. ,..._ -...�._L...-a'.i'.ifi s Unit qualifies for ENERGY _'_��-�-,-,, _;�� .-.'•>. 'f y STARS region(s):Norther,". ,f North Central,South Central, i ' Southern. VIA STC:29 Rein 00/Glass ProSoiar/H-LC25 DP:+2 5/-25 Tested Size:48"x solr F!&,,da Product A.porovai:FI-51 F? I AppiicabieTest Standard(sl: }OI1l/ IS.2/+AiO05 AAfv�JVVDNAC `1C'AAAAD NJ Air-SA 11JS.ti 40-08• r , A440S1-09 Canadian Suppl m HS Ho..ard 8400094A t�3d8i90,�t 80333 "` T .! CO ill r 'i i� Dqarmlerl of OV7Ne we oirin 'St" C ox Tress St7vet, Suite ION, H' bL4 ,9211 420-4"' www.1nass.,,_9v1dia a La3a-ra-ace iCo a trac ctricians[P lumbers tors/Ele Workers' CompeaiatjO -0davit: Bilildersi please Print Led—blv __kpvfican­t -L\jame (Businesslor-anizarion/In&ridual 0- L Address: 9 91:;L --Y> Phone clty/stale/zi):5� Vil-r ol) �o ,kre you an employer? Check thearopriate box: I Type of project(required): 4. 1 am a general contractor and I I 0 1 6. New GousnctiOu 1.F1 I am a-employer with ha-te hind the sub-contrwtM 1 - i employees(full and/or part-tirae).* listed on the attached sheet 7. Remodeling a sole proprietor or partner-1 These sub-contractors have 8, Demolition ship and have no am-P107res employee 9. Building addition es and have workers' wowing for me in any capacity. 0 comp.insurance.t 10,1:]Electrical.r5pairs or addihons Dfo workers' comp.insurance 5. W,-=-a corporation andit3 airs or additions required.] owner doing officers ham-,exercised their 11.[]P iunbing rep 3.C3 I am a.hO-me ina a.111 woi, right of exemption per MGL 12.[]/c.o f repairs MYSAL [\,io workers, Comp. c. 152, §1(4),and we have 110 in.,_1zMce recpair-,c]-] mploy-_es. [No works-rs' 13.0 other P comp.ingmance required] showing heir worker'mrapensatan 3OUCl/iMrormadon f A.X1 IpplicarlE that checks box 41 must also 511 out the section below Caring 3uch. indicating they ar-.doing 3fl work and then hire outside--owlact,,,must submit a acw iffidwiit indi . t Homeowners who submit this iffidwAt iELdi ofibc;sub­r�tors and state whether or got hose entities have rCorltraCtorS that Check this box must attached m additional sheet showing he name,cotiyaumb,,. employees. if the sub-contractors have­P1oY=,they must provide their workersomp.p Below is the policy and Job-site I on an employer that o"T PrFn,a workers'compensation insurance far my ZMP10Y ees.information. CW Insurance Company Name: Expiration Date: Policy Policy N or Self-ins.Lie.9: C-1 1,5- A4 Job Site Address:_ �Kap- City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and erpiration date). requiremm eron. 5MGanethcrbmbaes a Failurz to 3�ec=coveracge as requ WoR-X ORDER and a fine ane sot, weU ascivil penalties in the formOP d,up to$1,soo.00 and/or one-yearri Be advised that a copy of this statement may be forwarded to the Of ce Of of up to$250.00 a day against the violator. investigations of the DU for insurance coverage verification. 1 do hereby certY nder the pain and penalties of perjury that the information provided above is true and correct Si ature: T)at a Phone Official use only. Do not write in this area,to be completed by city or Own offidal. fl City or Town: Permit/'License Issuing Authority(circle one): ector g Department 3.City/Town Clerk 4. Electrical inspector 5.plumbing Insp 1. Board of Health Z. Building 6. other Phone#-. Contact Person: MMID CERTIFICATE OF LIABILITY INSURANCE DATE(021242/2016016 WW) 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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE FAA/C No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW*-16-17 INSURER A:Steadfast Insurance Company 26387 INSURED THE HOME DEPOT,INC. INSURER B:Zurich American Insurance Co 16535 HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD,NW INSURER D:Illinois National Insurance Company 23817 BUILDING -20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003741310-08 REVISION NUMBER:O 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 ADDL SUBR LTR TYPE OF INSURANCE WVDPOLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03/01/2016 03/01/2017 EACH OCCURRENCE $ 9,000,000 CLAIMS-MADE I-Ti OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 LIMITS OF POLICY XS MED EXP(Anyone person) $ EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 X POLICY 0 JE -LOC PRODUCTS-COMP/OPAGG $ 9,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAP 2938863.13 03/01/2016 03/01/2017 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTYnt DAMAGE HIRED AUTOS AUTOS Per accide $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ XCESSLIAB CLAIMS-MADE AGGREGATE $ EXCESS I I RETENTION$ $ C WORKERS COMPENSATION WCO 15519215(AOS) 03/01/2016 03101/2017X PER OTH- C Y/N AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WC015519217(AK,KY,NH,NJ,VT) 03/01/2016 03/01/2017 OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 1,800,000 D (Mandatory in NH) WCO15519216(FL) 03/01/2016 0310112017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 yes,describe under DContinued on Additional Page DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101 Additional Remarks Schedule m be attach ( may ed It more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER 1600 OSGOOD ST. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _McLuno ` t L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 1� (._�.:. C- 1.. �( t(� 1 t.;•,.f�i I.IL. {.-'diC-L.'.1+'�%'(/[ .J,' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5 170 Boston, Massachvisetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC. MARK NIADINA 2455 PACES FERRY ROAD, HSC C-11 _. .__._._------_-----...__----.------- ATLANTA, GA 30339 Update Address and return card,Mark reason fox-change. -� Address L Renewal –jEmpluywent (� Lost Card "/�r Y; rirr!�rr,irirrrr�/,�• ,%�i.,�fre,nruirr.�,i%r . tiof Consumer Affairs Business Regulation before or registration valid for individual use only before the expiration date, If found return to: me -k' OME IMPROVEMENT CONTRACTOR ptrce of consumer Affairs and Business Regulation Type: Ill Park Plaza-Suite 5170; Registration: 126893 Expiration: 8/3/2018 Supplement Card Boston,ivW 02116 THD AT HOME SERVICES, INC. THE HOME DEPOT AT HOME SERVICES MARK NIADNA 2455 PACES FERRY ROAD,HSC _._._— -— ATVANTA,GA 30339 Undersecretary Not vali .without signature v p tn, CSSL-099699 ROBERT POCZOBUT 172 WHALERS LANE SALEM MA 01970 0210812018