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HomeMy WebLinkAboutBuilding Permit #345-16 - 1160 GREAT POND ROAD 2/17/2015 BUILDING PERMIT oFtNOR%ORTH TOWN OF NORTH ANDOVER �,� y� ,, 4, oL o p APPLICATION FOR PLAN EXAMINATION Permit No --�" Date Received 4 �gSSAC HU`-+���y Date Issued: v,- IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER`. _ 001(-,3 J ».Se,4 t)o j W ' Print 100 Year Structure MAP PARCEL`. _ZONING DISTRICT ,._1=listonc,Distnct yyes ano w T' MachineShop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic _ ❑Well . ' '. ❑ Floodplain E1:Wetla64s . µ 1Naters ied;District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I entification- Please Type or Print Clearly OWNER: Name: /2 00 Phone: Address: Cor`itractor.'Name: `�CA6o9-.,AQ - 'r .Phxone. cl ?g aZG 5 33-S ( O w U u Email: 2 _ -Supervisor's Construction'License 47 ( J _ Exp Date[ -- i K 6 t r S Home Improvement;License` �:� G ,> hEXR 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: $ � li Check No.: i Receipt No.: NOTE: Persons cont•acting with unregistered contractors do not have access to ty and Signature of Agent/Owner Signature of contracto 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 Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 n I1N PLANNING & DEVELOPMENT Reviewed On Signature_ I � COMMENTS 60�1(k (}j CONSERVATION Reviewed on l Signature 1. 9,4 6�� U 1 - -d ' COMMENTS VL HEALTH Reviewed on Signature COMMENTS :Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 4 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE`DEPARTMENT, ; TernptDumpstbrao.nisite. ,yes ,M6 Fie•e4Department.sii nature/date COMMENTS 4 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) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Location fl�o T . No. Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 'f Check# s< i ,�. Building Inspector r• 1 V NORTH W1 . -c ve . No. 916 o 1 ver, Mass, coc"Ic"QW.C.f A°RATE V 'rfo S U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT ................ „ .... yr M BUILDING INSPECTOR has permission to erect .......................... buildings on/1*16.... ...' 1..Ad................................... Foundation . _ Rough to be occupied as ..o.... .. ......... .... .. ................................... Chimney provided that the person accepting this permit shall in every res t 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 /601 p . UNLESS CONSTRUCTI TA Rough Service .............. ........ ............. ............................... 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 Street No. Smoke Det. 2000M o-y` L l.p'•r � f� 4 � a .'� fir,� • S L AW ..- r d d •' �n = {�.- :.i• r"e"3r�,.. ly�t s,' f''S � £,`^' � t- x�.a.+r. _ d` ''.9' xs``_"/" �^ri "�," f'^':�-.,�. ,± � � "'i� %., '`• �L. t � S ..�. `r'� Yr �� R - �'1}:�'ht�y�•S„�_.?f"f�y� C� 1 x4 w .t V • +r 1. !'•- :cr Lia• i�f'/ .a _ y�j i S; /3r-rv'e 1 4 '3_ : rr 3 ' '. .1 '1 ,-,fig"—. ;.,•• ,i .,sy� �= � 1 � � �• , —.. ,. /h{y3 I' '•�,.� FI r.,, � �:..r�y� 3+t s`. � - ti �BBBB6 .J m r �ry�v. \ .; � __ �«f'•• r `k •L . 1• e- ��J _jam �" j, .i "'.•��/ ( "` ���� 1����py �j �'� - �. ',ate �^� , +3. a >.;ova IIS k 1'Itl'�.,-I T /lg'a•• �� t •' .Ij' 4. • c -X9 Dillon House°Hirt , \tel \ Hayden Smith House•Haile \ yr w"� -0 Russell House•Alami,Shovan,Benson,Skinner , IN New House 2A•Latham q aa,� \ j�*ar �` Al ,4f,•+3>Y \ i �''b_a` ^L'T•yS ay �b - ls'a� +r -;�: -`.*y + -?�Mf - _ .-- ' --•,�.�� t b C) S 1 \ s�j ya ' .3 /' , Y-",? -�+ , - {1,i ,�V71Z,j Z Ft _ - r ._. r3.a•�'•'. New House 2B Hesse \� r.AM ��� _--. '• _ ¢_- �W _"/' �•-"J�.r-__-_ �rte. 3.� New House 1B°Ellerton t tmiy� '' --� ',t—�^�---�• } t' t :n Eaton House•Konovalchik ' Head of School's House•Packard \, h r - +, �rx f Thorne House•Flanagan,Mendez-Penate,Jones k \;F` ;:4 g Buhl House(Whitney) irich Peabody House°Stuart and Sahs � � ( y)° Wilder Dining Hall Gardner House•Crowley,B.Smith - F Hettinger West•Nam,Lazar g Henry Luce III Library Hettinger East•Perkins/Grant and Mattison Holcombe House°Heinze and Vicente-Quesada Goelet House° Charpentiers Facilities Building -> : Admission Office 1 Chace House(Construction to be Compreted ®Johnson Classroom Building Williams House•Fuhrman I I Fa112012) °Palm,McVeigh,Waters Danforth Center Health Center PBA Dormitory° Carabatsos ®1 Rogers House°Shea ®1 Head of School's Office Stevens House•Camerons Andrew House•Hamilton Holcombe Boat House Arel House(PBA)°Ries ®Auditorium Robert Lehman Art Center I . Thompson House•Burbank/Crump-Burbank Arts Building I 1 Science Building I Lyman Boat House Blake House°D.Callahan,Kelly ® g Merriman Dormitory°Gilbert,Zipin y Vanoff House(Blake)° Campbell ® Frank D.Ashburn Chapel Whitney House°Fahey Dearborn House•Kellers I : Athletic Center Jackson House(Thorne) ° Grahams I Center Farmhouses°Baker,Salichs,McDowell I Bertles House(Gardner)°McDonald I Bigelow House°Richard I Business Office/Technology Department .. .. ........... CI - b.1. a r e' r '..t V �\ ,'••"• 'S `� ".y'..f x�`�`,-/•'.^.' . •Y41-1, ,.^� f"-.r•. •#. ` i ,d-_ t �"ttr'``C_r / y,�:a Y .a �.y ;-1`" f' h'"Wr('•{ _ < I t ;7 r i' Y� Im e 9 , a f'• r S, ir���r!' �, f - L > AN r ^ ✓,�3.e I ,!.. � , .._ -v}�/ r,, • J ' a 1. f �.-� �b- ..` • - Irl -.�. SFT a ` t ,� • � iY •1 F I 4ry,• �,ii �Y:,i, tl ! *� [�j� "j�`+ ..�, �a'�'!([ � C�-> T_ �.;' ��' �f , a e'° .. �V +q� �4•�•9 .. � �v •. / • � :�. f \��f.t �I-'"1_.l�.. � �;s,T� �� C` -�! I�,,.�z., `r • � y' � ��,�, •Arf*i a /,� �.. _ . Dillon House°Hirt �> tk�e>r/ C �• `�l r i rix _ lr f+ i / y'#✓(.�P i it } e ) ��_ ��` �.`.\ _� � � •� 'raj"� _ -, � � �d <...`.� Hayden Smith House°Hazle `� �, - �_ ` Russell House°Alami,Shovan,Benson,Skinner New House 2A LathamNew House 2B•Hesse , VsNew House 1B•Ellerton Eaton House•Konovalchik j Head of School's House•Packard x` l ,o \ ,' syr' Peabody House•Stuart and Sahs Thorne House•Flanagan,Mendez-Penate,Jones Buhl House(Whitney)•Oirich - ' ® Gardner House•Crowley,B.Smith ' Hettinger West•Nam,Lazar Wilder Dining Hall Henry Luce III Library Hettinger East•Perkins/Grant and Mattison Facilities Building Admission Office Holcombe House°Heinze and Vicente-Quesada Goelet House° Charpentiers 1 Chace House(Construction to be Compreted ® g Williams House^Fuhrman Johnson Classroom Building I I Fa112012) °Palm,McVeigh,Waters Danforth Center Health Center PBA Dormitory• Carabatsos � Rogers House•Shea �Head of School's Office Stevens House•Camerons Andrew House•Hamilton .` Holcombe Boat House I . Arel House(PBA)•Ries ®Auditorium ®Robert Lehman Art Center - Thompson House•Burbank/Crump- Burbank Arts Building I 1 Science Building . Blake House°D. Callahan,Kelly ® g Merriman Dormitory° Gilbert,Zipin Lyman Boat House Vanoff House(Blake)° Campbell ® Frank D.Ashburn Chapel Whitney House°Fahey Dearborn House°Kellers AM I : Athletic Center Jackson House(Thorne) • Grahams QD Center Farmhouses°Baker,Salichs,McDowell Bertles House(Gardner)•McDonald Bigelow House•Richard Business Office/Technology Department i The Commonwealth of Massachusefts z . h Department of IndlusirlalAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www rnassgov/dia Sy Workers'Compensation Insurance Affidavit:Builders/Contractors[Electricianslplunabers. TO BE RILED WITH THE PERRAU TING AUTHORITY. ApOicant Information Please Print L�ep/ibl Name,(Business/Organization/Individual): (I C"(, 't34 Address: if �� 67?1 �� !i(� /��`7/ City/State/Zip: t,%_ --tqvrU V-01, d/8`( �7 Phone#: 17 aL Areyou an employer?Checkt&appropriate box: Type of project(xequired): 1-6I am a employer with_.7 employees(full and/or part-time).* 7. ❑New construction 2.Q I ama sole proprietor or partnership and have no employees working for me in &. F!Remo delixig any capacity.[No workers'comp.insurance required.] g. ❑Demolition I Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10[]Building addition 4.0 lam a homeowner andwill be hiring contractors to conduct all work on my property. twill ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insruaace.9 6.Q we are a corporation and its officers have exercised their right of exemption perMGL c, 14.F1 Other 152,§1(4),and wo have no,employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheirworkers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work andthea 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 . e employees,they must provide their workeis'comp.policy number. employees. l£the sub contractors hav ' lam an employer tT at ispi'oviding workers'compensation insurance for my employees.' below is thepolley and,lob site information. ^ „/9 c- Insurance Company Name: �( Policy#or S elf-ins,Lie.#: Z U a 4o 0Expiration Date: Job Site Address: 1 L U7 City/State/Zip: AJ, PO LPt Attach a copy of the workers'coxnpensation'policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cer ' un er ains ndpena t's ofperjury that the information provided above is true and correct Si afore: Date: l� Phone#: C)�.L.C F 3 O' J Official use only. Do not write in this area,to he completed by city or toren 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 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their emp oyCos. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract 6f Hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,ox 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 b6 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 have been presented to the contracting authority." .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•phonenumber(s)along with their certificate(s)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 maybe submitted to the Department of IMustrial Accidents foi confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the ci or town.that the application for the ermit or license is bein requested,not the De�artment of city .or p g q ..� p Industrial Accidents. Should you have any questions regarding the law or ifyou'are required to obtain a workers' compensation policy,please call the Department.at the number listed below. Self-iir'sured 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 the bottom 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/license number 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 current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 021.14-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia c . 9 i RICHARD FLUET 02 BRIDLE PATH LANERACTING, INC PROPOSAL METHUEN, MA 01844 Date Estimate# 6/29/2015 527 Name/Address BROOKSSCHOOL 1160 GREAT POND RD. N.ANDOVER,MA.01845 THORNE Description THOENFJCONSTRUCT NEW ROOFS OVER TWO ENTRANCES SUPPORTED BY 8"ROUND FIBERGLASS COLUMNS..CUT ADS AND INSTALL 4'DEEP X 10"SAUNA TUBES,2"X 8"TRIPLE HEADERS,2"X 6"RAFTERS 16"O.C.,5/8"FIR PLYWOOD, 8"ALUMINUM DRIP EDGE,LIFETIME CERTAINTEED SHINGLES.TRIM EXPOSED AREAS WITH AZEK,INSTALL WHITE VINYL SIDING WITH A BEADBOARD CEILING,PAINT COLUMNS.SUPPLY PERMIT AND TRASH REMOVAL.$7600.00 EACH $15,200.00 TOTAL PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$85.00/HR/MAN. MA.LIC.#50710 HIC.# 106620 FINANCE CHARGE OF 1&1/2%PER MONTH FOR UNPAID BALANCES. AS WORK PROGRESSES. Total $15,200.00 Signa 4e Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@verizon.net uc" QrM ,° g Lf �lei c C < T L• '� l �a F`( Tilei tom, =- ---- -- 44 `f ACORO" OP ID.CH CERTIFICATE OF LIABILITY INSURANCE DATE 09/1 012 0 1 YY, 09110/2015 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 terns 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 endorsements. PRODUCER CONTACT Segreve&Hall Insur.Assoc.inc NAME 305 North Main St PHONE p Andover MA 01810 raC,Ne.E*n A!c No Michael L Segreve .ADDRESS: CROSTOMER I .FLU ET-1 ng rac Richard Fluet Contracting Inc. INSURER AFFORDING COVERAGE NAIC q INSURED INSURERA:Arbella Protection Ins.Co. 41360 Me Bridle Path Lane INSURER B:•Commerce Insurance Co. Methuen,MA 01844 34754 INSURER C: 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. INSR S LTR TYPE OF INSURANCE POUC POLICY EFF POLICY EXP GENERAL LIABILITY Y NUMBER MMID MMIDO LIMITS EACH OCCURRENCE S 1,000,00 A X COMMERCIAL GENERAL LIABILITY 8600034727 06/12/2015 06/12/2016pREMISEs Ea oaLrrance S 100,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,00C X POLICY PRO• LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ee accident) ALL OWNED AUTOS BODILY INJURY(Per person) S 100,000 B X SCHEDULED AUTOS BODILY INJURY(Per accident) $ 300,000 PROPERTY X HIRED AUTOS XV1460 12101/2014 1210112015 (PER ACCIDENT)DAMAGE $ 100,000 X NON-OWNEDAUTOS $ UMBRELLA LIAR OCCUR S EXCESS UAB CLAIMS•MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE 3 RETENTION S $ WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY WC STATU• OTH- A ANY PROPRIETORIPARTNERIEXECUnVE YIN 9104340312 03131/2015 03/31/2016 M RH OFFICERIMEMBER EXCLUDED? ] NIA E.L EACH ACCIDENT $ 600,00 (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AddlUonal Remarks Schedule,if moro space Is required) CERTIFICATE HOLDER CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael L.Segreve 1Z_L ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD ��e.(F70?77/IYGdI2U/eCLLG�a���.c��rrcf rr,tel/,t`; _ Office of Consumer Affairs&Business Regulation ME IMPROVEMENT'CONTRACTOR egistration: $06620 Type: xpiration ;7/24/206 Private Corporation RICHARD FLUET G-ONYPV,CT_K :INC. Richard Fluet l, 102 Bridle Path Lane tiy �,,r•: Methuen,MA 01844 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards - 0-11-1 trucfif)il Saiilci-�i±fii License: CS-050710 ~ { RICHARD A.FLU�`I 102 BRIDLE PAT" � � METHUEN NIA 0184 r ,y ..Expiration 04/22/2017 Commissioner