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HomeMy WebLinkAboutBuilding Permit #791-2017 - 110 QUAIL RUN LANE 2/22/2017 t _ NORTH BUILDING PERMIT °� LE° qti 2 y6�t�. ..:ahb s6 ° TOWN OF NORTH ANDOVER o ;y . _---';• APPLICATION FOR PLAN EXAMINATION T b co ^� Permit No#: 1�• Date Received �19A°Rwreo PC SSACHUSE Date Issued: Aam O TANT: Applicant must complete all items on this page �. Z' -T Y�01I� ER� � � tru�ct�wre yes - qui P) PP�RCEL _ ZONlNGSISy_rR1CHls`torlrD�stnc# S � TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other u fl Sept c ®r1Ne11 y 9 loodplatn ;,O Wetlands x I] Watershetl Distrie p �. F,.,3 _ .: ,i. DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: c j `- 'E.- '°.` ✓.f^ ,P'^"'�":�y°"�,�� ',ait "fix t Y''t• sc ti7a. �yS.rri.h+a°%l..tr.. ^'� A '�."��f T ' i •-..'L .5. � "!,*�° C �, •- - a 'e' �7 .-S as.�r.. '` � �,.� Contractor Namerltrr,rat �� u. r hone IZ u i A'ddrESS" Hat i' "'q:"s`-�4..""-�'w, y`,� a;Fss RSA. t s n x -..at;rr ar y...,x+^-.�.• , � .� ,,,� �fJ, ''P -S ervisors Construcfion=L cense ` ` � + ti �` P<a ` iso * �• t µ. � $#'� s'x rr .�. •�-a.3 .. -ka,�� 5 r �Y's.£T"� l€, t*'�,, �}st- ,pr.,,�`.di°s S eImproe�men, L�cense ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ U 1 . K C) FEE: $ Check No.: 1 "I V� Receipt No.: , 3 ( � NOTE: Persons contracting with unregistered contractor n t 1 ve acce s to the guaranty fund -- - Si, na : �nnati ire nfi Anent/Owner q_ _,t_ce o tractor . j— Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS _Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: FIR ;iDE-P _ Located 384 Osgood Street r AR7MENTTempDumpster on site: yes �r. . ono r 4t �, jl qL• sated at124 MainSfreet _ T �x-g- . , Fire�Departmentsigna' Nr e/date =� .� ,kf �r �� ' CO IVI E NTS.` -g s 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 - Doc.Building Permit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ 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.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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 ❑ 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 ❑ Mass check Energy Compliance Report ❑ 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 Location Lf t" t No. FII " - C' Date �—��17 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $4,67- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � /it J • Building Inspector l RTH Town ofti?, NAndover 200 I No. h ver, Mass - 7 a • a- 0 1. CONIC N!WKN U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT1K.��1..�!..!'M. ..1�/1 ���'!�..., �1/,�V�1l; e i4!y, , BUILDING INSPECTOR has permission to erect .......................... buildings on ......... 1. 0....GL.u.r.+..4..L...�!tA,04 Foundation ....�... � Rough to be occupied as ..... .4.�. V.��..�.'�....../... Ii' s.!!......K/...............or............!...`................ 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 RT 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. V L ?\3 o Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 y 1 f MA Contractor Registration No 120979 ,1� CT Contractor Registration No 620120 RISE ENGIN€EKING 60 Shawmut Road,Canton,NIA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE cum* WORK ORDER Rosalie Pulverenti (978)685-0606 12/15/2016 444622 28602 SERVICE STREET BILLING STREET 11.0 Quail Run 110 Quail Run SERVICE CnY,STATE,ZIP SILUNG CITY,STATE,ZIP North Andover,MA 01845 North Andover, MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful.excess air leakage. This work will be performed in $1,020.00 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 attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(12)working hours.A reduction in cubic feet per minute(efm)of air infiltration will occur,but the actual number of efm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the 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. AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doorswccp to(3)doors)to restrict air leakage, $240.00 KITIC FLAT:Provide labor and materials to install a 5"layer of R-16 Class 1 Cellulose added to(288)square feet of floored attic space. $504.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaccd fiberglass batts to(232)square feet for damming purposes. $475.60 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-37 Class i Cellulose added to(644)square feet of open attic space. $1,004.64 ATT1C ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface $237.65 of plywood will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom $237.50 fan(s).Broan model#636 or equivalent. VENTILATION:Provide labor and materials to install ventilation chutes in(105)rafter bays to maintain air flow. $262.50 h Federal iD#054W6629 RISE Engineering RI Contractor Registration No 8186 X11 r� MA Contractor Registration No 120979 ;. CT Contractor Registration No 620120 RIS60 Shawmut Road,Canton,NIA 02021 ENGINEERING CONTRACT 339-502-5197 FAX 339-502-4345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT# WORK ORDER Rosalie Pulverenti (978)685-0606 12/15/2016 444622 28602 SERVICE STREET BILLING STREET 110 Quail Run 110 Quail Run SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 .TUB DESCPJPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible $90.00 measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year.and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional S340 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 weathcrization 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 weatheri7tation incentive is$3,110, The Permit will be secured by the insulation contractor,at no additional cost.it is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. Total: $4,071.89 Program Incentive: $3,110.00 Customer Total: $961.89 WE AGREE HEREBY TO FURNISH SERVICES,COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Nine Hundred Sixty-One 81891100 Dollars $961.89 UPON FINAL INSPECTION AND APPROVAL.BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION OH GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. B AU D" TURE-RISE99-irwedny )-. 4 ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES, PECtMATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTf .YOU ARE AUTHORZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE The Commonwealth oflllassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aulicant Information Please Print LeLyibly Name(Business/OrganizatiorAndividual): Merrimack Valley Insulation Corp. Address: 23 A Sullivan Rd. City/State/Lip_Billerica—MA_01862 Phone#: 978-888-3495 _ Are you an employer?Check the appropriate bog: Type of project(required): 1. X❑ I am a employer with 18 4. E] lam a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [❑Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.+* 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I_❑ Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. f c. 152 ❑ Roof repairs insurance required.] ,§1(4),and we have no employees.[No workers' 13.93 Other Insulation comp.insurance required.] ,Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have empioyees. If the sub-contractors have employees,they must provide their workers'comp.policy number. rain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5Star V3 AAIC American Alternative Insurance Policy#or Self-ins.Lia#: V9WC749118 Expiration Date: 6/18/2017 Sob Site Address: (0 �I �Yy City/State/Z,ip: A Ul�y6' 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 pains and penalties of perjury Hurt the information provided above is true and correct. Signa Date: `a t - )'1 Phone#: 8-888-349 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#: MERRVAL-03 WEJE CERTIFICATE OF LIABILITY INSURANCE____ oATE(AItNDarYYYY) 6/1312016 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- i CONTACT Automatic Data Processing Insurance Agency,Inc PHO E - 1 ADP Boulevard AIc No Ext: FAX AC No Roseland,NJ 07068 ADt"DA1 . INSURERS)AFFORDING COVERAGE NAIL _. INSURERA:Jr'Star V3 AAIC American Alternative)nsuT3n. INSURED Merrimack Valley Insulation Corp INSURER B: 23a Sullivan Rd INSURERC: North Billerica,MA 01862 -�- -- ---. - --- INSURER D INSURER E— — -- ------- INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. tdarwiCHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH 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. fNSR ----___------------- `- A SBR --------- LTR TYPE OFINSURANCE 1- y,p PO NUMBER —PMpp iff 'fy j� Y aP - LIMBS 'GENERAL LIABILITY EACH OCCURRENCE IS i CAMMERCIALGENERALUA81LITY i PREMIS:T0McTED- - S _ t I - CLAit tdAOE71OCCUR 1 WED EXP(Any_ ---- 1 one person)_ -- PERSONAL&ADV INJURY S -!- ----- i GENERAL AGGREGATE _ S GEN'LAGGREGATE LIMIT APPLIES PER: t ;PRODUCTS-COMPIOPAGG S^ v— POUCY ,'JE OT 01 LOC j ---- S AUTOMOBILE LIABILITYCOMBINED SINGLE UMfr ea accident S _ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS j j i 80D1LY INJURY(Per acddeM) S AUTOS I HIRED AUTOSi 1 PROPRT EY DAt,AAGE -- � it I t P_er_an_ciden_t 5 UMBRELLA UAB OCCUR ; EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE s - DED RETEN7)ONS �-� S --- WORKERS COMPENSATION 'C'Ali OTH- j AND EMPLOYERS'LIABIUTY X TORY _IT ER A J FSJYPROPRIETORIPARTNERIFXECUTDfe YIN 9WC749118 6(18!2016 6/18/2017 E.L EACH ACCIDENT S—v_- 1,000,00 l OFFICERIMENMEP,EXCLUDED? Q N!A _ (Mandataryin It yes,describe uunder ` E.L.OISEASE-EAEfdPLO S — 1,000,00 n DESCRIPiIONOFOPERATIONS bHmi ! E.LDISEASE-POLICY LIMIT 5 1,000,00 t I DESCRIPTION OF OPERATIONS I LOCA nomsi VEHICLES(Attach ACORD 101,Additional Remarks§chew%if 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 Town of North Andoeer,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andoxer,MA 01845 UTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(Ml 0106) The ACORD name and logo are registered marks of ACORD ''111. ! n� CERTIFICATE OF LIABILITY INSURANCE DATE(18120YYYY) 02/18/2017 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 have ADDITIONAL INSURED provisions or 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 E cT Carolyn A Coughlin Charles J Coughlin InsuranceNAME: (978)957-3588 FAX 14 Dinley Street A1C No): R 0.Box 10 A , carolyn@coughinins.com Dracut,MA 01826 INSURERS AFFORDING COVERAGE NAIC p INSURERA: Northland Insurance Company 24015 INSURED M?rrimackValley Insulation Corporation INSURER B: Safety Standard 39454 Joseph A.Ryan,Jr. INSURERc: Starstone Specialty Insurance Company A0242 23A Sullivan Road R Billerica,MA 01862 INSURER D: 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. IL� TYPE OF INSURANCE ADDL SUER POLICY NUMBER MPS Y EFF PIYYYYJ OLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY VMR833 01/21/2017 1/21/2018 EACH OCCURRENCE $ 1,000,000 D E T RENTS CLAIMS-MADE �OCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Ary one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY E]E�RO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY 6205006 11/25/2016 11/25/2017 COMBINED SINGLE-LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OVTOS AUTOSSCHEDLED BODILY INJURY Per accident $ AUTOS ONLY IV AUTOS ( ) _ KRED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY $ Per aoadert C V UMBRELLALIAB OCCUR 875931-172ALI 01/21/2017 01/21/2018 EACH OCCURRENCE $ 1,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENT10N$0 $ WORKERS COMPENSATION PER OTI+ AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.FACHACCIDENi $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it mare space is required) Insulation Installation CERTIFICATE HOLDER CANCELLATION Fax#.(978)688-9542 SHOULD ANY OF THE ABOVE DESCRBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ��" ' r �/�Q �����l��Zf1�17�11F'�fX�t�y1j f� • �.•,/�Gf��£.,;.'Cy22.'G����• Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home improvement=Contractor Registration Type: Corporation Merrimack Valley Insulation Corp;, W. -` " Registration: 180508 - Expiration: 11J23J2018 23 A Sullivan Rd y Billerica, MA 01862 f Update Address and return card. Mark reason for change. SCA i 0 2M-Ml 0 Address 0 Rene--i 0 Empkny--�nt n-Inst Card n1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only a,k itt � Jf Type: Corporation before the expiration date. If found return to: edgi tSr tion iration Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 t8�546 11(23/2018 Boston,MA 02115 Merrimack Valley Insulation Corp Joseph Ryan 23 A Sull'nran Rd C --- Billerica,MA 01882 Undersecretary NOt vs id ithout signature s Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CS-075541 Construction Supervisor , C_tMW` JOSEPH ALEXANDER RYAN,JR 356 OLD WESTFORD RD CHELMSFORD MA 01824 %: �• •�� Expiration: Commissioner 02/04/2019