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HomeMy WebLinkAboutBuilding Permit #196-11 - 120 OSGOOD STREET 9/8/2011 TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION permit NO: �� ` Date Received A Date Issued: 1 ORTANT:Applicant must complete all items on this page LOCATION 1 �_ O 74 oe print Jr- PROPERTY OWNER A- � �. Print MAP N0: PARCEL04 : � ZONING DISTRICT: Historic District yes no Machine Shop g Villa e Yes no TYPE OF IMPROVEMENT PROPOSED USE Reside ' I Non- Residential ❑ New Building ne family ❑Ad ' 'on ❑Two or more family ❑Industrial fetation No. of units: 11Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: El Demolition ❑Other .wea-j - i.c. -.- �.zw't•�r-r t.:"i'tY'yF .-1'fJr � _ < -' c ,, .- - - :^ ...v Septic_ ' ®Well ®=T�loodplaul� jl7'Wetlands,�" .i 10'Watershed Dlstrtct ; ! � * 4 Maier/8eNer '-..`._. - DES i i tON Or WORK TO 3E-EUIO_ D: (Identification Please Type or Print Clearly) OWNER: Name.—, C;nn co Phone: Address: CONTRACTOR Name: Address:,N 4= -/V 6_Yns Supervisor's Construction License: 1(o Exp. Date: / Home Improvement License: �lo )VZ Exp. Date: ARCHITECT/ENGINEER z Phone: Address: Reg. No. FEE SCHEDULE:B ULDING PERMI r.•$12.0000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$12500 PER S.F. • � �- 7 FEE: $ Lo q I ./ Total Protect Cost. $_ . Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors d .not c, ss to the guaranty f d Si natu�e:ofAgeri�Own. r:_ _ _ - --- _,:9.�-,---....__-•—_==x-= = - --- - ■ 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(Salcs ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 1.24 Main Street Fire Department 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 Wer location, lust 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- Date Doc:.Building Permit Revised 2008mi Building Department The following is a list o;the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Inferior Rehabilitation Permits ❑ Building Permit Application ❑ ln/orkers Comb 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.L.C. And C.S.L. Licenses ❑ Copy Of Cont-ract ❑ Eloor/Crossectiion/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 ff'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: Doc.Building Permit Revised 2008mi Location 12.4D �c� No. ! Date NOo TOWN OF NORTH ANDOVER `•o •?aO O F R 9 }�a Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # S� 24557 Building Inspector u NORTH TO'" Of o , �` dover, Mass.,LAKE q•• S• 1� COCKICMEWICK %S RATED Pf�o BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................... w'{' ...... ...................v............................................................................. Foundation has permission to erect......................................... buildings on ... ........ +-1. .0AX........................y............ Rough to be occupied as........ . � ..r... .. .. ...0... ..... Chimney provided that the person fccepltingthis permdshallin eve respect conform to the terms of thea lication on file inthis office, and to the provisions f the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 oil .� ELECTRICAL INSPECTOR UNLESS CONSTRUCTIGS Rough ........................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final T No Lathing or Dry Wall 1 o Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE. Smoke Det. SEP-08-2011 09:00 BWN 1 603 437 2606 P.001/001 Kanayo Lala, P.E. .............08/24/2011 PROJECT: Fredo Residence 120 Osgood Street,N Andover,MA DESIGN FOR-GIRDERSMOISTS/RAFTERS Attic Beam Al at the bearing wall to be removed LOADS: DEAD LOAD 12.00 PSF 168.00 PLF Ce= 1 CF= 1.00 SNOW LOAD PSF 0.00 PLF Cq= 0.9 Cs= LIVE LOAD 21.43 PSF 300.00 PLF qs= 24.7 Cd= 1 TOTAL LOAD 468 PLF 1= 1 Cm= 1 WIND SPEED 100 MPH p= 22.23 PSF POINT LOAD LBS 3 FT Ra= 0 LBS 3393 LB=TOTAL REACTION TRIBUTARY WIDTH 14 LF E= 2000000 PSI JOIST/GIRDER SPAN 14.5 LF Fb= 2900 PSI WIDTH- IN 3.50 PSL/LVL 11.25 IN = d Fv= 285 PSI ROOF PITCH- N:12= Fc= 2700 PSI Fcp= 750 PSI MOMENT= 12300 LB-FT MOMENT2= 0 LB-FT 73.8 =S provided OK S= 50.90 IN^3 415 = 1 Deflection= 0.560 IN = 310 For Total Load Required 11180 Deflection2= 0.000 IN = 484 For Live Load Required(1240 Fcp'= 646 PSI OK 1.50 In Bearing Length Fv'= 129 PSI OK icor cn=Kanayo, o, ou=Lala, V"L4u email=kanayolala@gmail.co N t3o.3371CC ' I C f'PlC1STCat`� m, C=V J fSStQ Al �� 2011 .08.2412:3 7:02 -04'00' TOTAL P.001 (for office use only) BOARDWALK A Division of Data Industries, Inc. Office .... . . . ..... . ... .. 24 Orchard View Drive Order NO..... . .... . . . . ... HmHboardwalknorthxorn Lon dondNH TEL(603)437-2erry, -2500 03053 Checked by . . . .. .. . . . . . . . Purchase Agreement Name of Purchaser(s) Scot and Kristen Fredo Email Address 120 Osgood St North Andover MA 01810 (No.) (Street) (City) (State) —,��, (Zip) Mailing Address if different SAME Ph910-00 Phone No. `T U 88 WORK SPECIFICATIONS We will furnish and install the Mchen Remodel as specified below: PAGE 1 OF I THF pi lgc,1 A qF A CRF-RM>•NT is PART AND PARCEL TO THE FREDO PROPOSAL FEATURES CONSISTING OF FOUR nACIFe ENDORSED AND DATED BETWEEN THE PARTIES AND AS SUCH REPRESENT THE TOTAL SCOPE OF WORK TO BE COMPLETED UNDER T141S AGREEMENT THE UNDERSIGNED PARTIES ARE IN SAID AGREEMENT AND AS SUCH AQRFE TO ALL THE TERMS AND CONDITIONS SET FORTH WIT"IN THIS PURCHASE AGREEMENT.ANY Ff TRTHER AGREEMENTS BETWEEN THE PARTIES SHALL BE FURTHER SPECIFIED AND ENDORSED UNDER SEPARATE COVER Remarks This contract supersedes all conversations, statements and Price and Payment- Cash price.................................... $ 90,936.00 agreements expressed or implied,between the parties,their agents and representatives. Payments to be made as the work progresses as per the Payment Schedule e p of this Contract: - - r Purchaser(s) authorize Boardwalk North to investigate credit which is attached and worthiness. — _—_ Date—___ j T17110-- l�✓� All work started above to be completed in a workmanlike manner Owner according to the floor plan,job specifications and terms and con- ditions as stated on the back of this form. _ Date_R__A,2 ner Boardw k o 08/12/11 B ------- Date------------- FREDO PROPOSAL FEATURES 8/12/11 OVERVIEW 1. REMODELING THE KITCHEN, LOCATED AND SIZED PER THE CONCEPTUAL/CONSTRUCTION DRAWINGS DATED AUGUST, 2011. TO INCLUDE ROUGH AND FINISH CARPENTRY, ROUGH AND FINISH PLUMBING, ROUGH AND FINISH ELECTRICAL, INSULATION (AS REQUIRED DUE TO THE REMODELING EFFORT), DRYWALL (MUD, TAPED, SANDED kl-;D PRIMED). ALSO INCLUDES PATCHING OF THE INTERIOR DRYWALL WHERE NECESSARY AS A RESULT OF THE REMODELING EFFORT. KITCHEN REMODELING: DEMOLITION 2. REMOVE AND THE EXISTING KITCHEN CABINETS, COUNTERTOPS, SINK, FAUCET AND KITCHEN FLOORING. THE DISHWASHER AND REFRIGERATOR WILL BE REMOVED FROM REMODELLING AREA (COMPANY CAN NOT BE RESPONSIBLE FOR ANY DAMAGE OR THE SERVICEABILITY OF THESE PRODUCTS UPON REMOVAL). ALSO INCLUDES REMOVAL OF THE EXISTING WALL SEPERATING THE DINING ROOM AND KITCHEN AND INSTALLATION OF NEW SUPPORTING BEAM ABOVE CEILING. KITCHEN REMODELING: WINDOWS 3. REMOVE AND REPLACE EXISTING WINDOW ABOVE THE KITCHEN SINK WITH A HARVEY INDUSTRIES BRAND TRIPLE CASEMENT AND (1) SINGLE �'A-87E QT WINDOW (OR SIMILAR AS DETERMINED BY COMPANY). PER THE CONCEPTUAL/CONSTRUCTION DRAWINGS DATED AUGUST, 2011. WINDOW INSTALLATION TO INCLUDE REMOVAL AND REINSTALLATION OF SIDING AND EXTERIOR TRIM AS A RESULT OF THE REMODELLING EFFORT KITCHEN REMODELING: ELECTRICAL 4. PROVIDE AND INSTALL NEW I I OV GFCI PROTECTED CIRCUITS LOCATED TO ACCOMMODATE THE REMODELED KITCHEN AND AS DE'rERMINED BY THE COMPANY. ALSO PROVIDE AND INSTALL (12)RECESSED LIGHT FIXTURES, (2) PENDANT LIGHTS (DISTRIBUTED BY WEST ELM, STYLE: SHORT DRUM PENDANT)EACH TIED INTO A THREE-WAY SWITCH, WITH ONE OF THE SWITCHES BEING A DIMMER CONTROL UNIT. ALSO INCLUDES (5)XENON UNDER CABINET LIGHTS OPERATED ON A SINGLE POLE SWITCH. 4a BUFFET ELECTRICAL: PROVIDE AND INSTALL (1)NEW}TENON UNDER CABINET LIGHT AND (1) LOW VOLTAGE ACCENT LIGHT BOTH OPERATED ON A SINGLE POLE SWITCH WITHIN BUFFETT CABINET PER THE CONCEPTUAL/ CONSTRUCTION DRAWINGS FREDO PROPOSAL FEATURES 8/12/1l KITCHEN REMODELING: HEATING 5. INSTALL (l)ELECTRIC TOE-KICK SPACE HEATER WITH INLINE CONTROL UNDER KITCHEN SINK AS SPECIFIED BY THE COMPANY. KITCHEN REMODELING: FLOORING 6. REMOVE THE EXISTING VINYL FLOOR DOWN TO IT'S SUBFLOOR, THEN PROVIDE AND INSTALL NEW TILE FLOORING UTILIZING THE EXISTING SUBFLOOR. (NEED FOR ADDITIONAL SUBFLOORING TO BE QUOTED UPON REQUEST) KITCHEN: CABINETS 7. PROVIDE AND INSTALL "DURA SUPREME" BRAND IN DESIGNER LEVEL (OR SIMILAR IN PRICE AS DETERMINED BY THE COMPANY.) CABINETS TO INCLUDE ALL PLYWOOD CONSTRUCTION, ADJUSTABLE SHELVES, FULL EXTENSION, SOFT CLOSE DRAWERS AND SOFT CLOSE DOORS.NOTE: PER CURRENT CUSTOMER SELECTION, DOOR STYLE TO BE CRAFTSMAN PANEL PLUS IN CHERRY WITH COCOA BROWN STAIN (OR SIMILAR.) BASED ON THE 20/20 KITCHEN AND BUFFETT CENTER LAYOUT. NOTE: ANY MODIFICATIONS FROM THE 20/20 KITCHEN LAYOUT TO BE QUOTED SEPARATELY UPON REQUEST. KITCHEN: CABINET HARDWARE 8. PROVIDE AND INSTALL KITCHEN CABINET HARDWARE PER THE CONCEPTUAL/CONSTRUCTION DRAWINGS (MODEL: AMEROCK 128mm PULL ESSENTIAL'Z.PART BP24013SN) KITCHEN: COUNTERTOPS 9. PROVIDE AND INSTALL GRANITE COUNTERTOPS (OR SIMILAR IN PRICE AS DETERMINED BY THE COMPANY), LOCATED AND SIZED PER THE CONCEPTUAL/CONSTRUCTION DRAWINGS AUGUST 2011.NOTE: FOR COLOR SELECTION AND EDGING OPTIONS SEE BOARDWALK NORTH SPECIFICATION SHEET. KITCHEN: TILE BACK SPLASH 10. PROVIDE AND INSTALL A NEW TILED BACKSPLASH, USING A 6"X 6" GLAZED PORCELAIN FIELD TILE WITH 3" INSET OF LINEAR GLASS TILE ER THE CONCEPTUAL/CONSTRUCTION DRAWINGS AUGUST 2011 KITCHEN: PLUMBING 11. PROVIDE AND INSTALL(1) ONE NEW ARTISAN BRAND, 16 GAUGE, SINGLE BOWL UNDERMOUNT KITCHEN SINK (MODEL M3] 18-D9) TO INCLUDE A NEW FAUCET(MODEL K-596-CP) AND REINSTALLATION OF EXISTING GARBAGE DISPOSAL. 2 FREDO PROPOSAL FEATURES 8/12/11 KITCHEN: DRYWALL 12. PROVIDE AND INSTALL DRYWALL TO ALL AREAS AFFECTED BY THE REMODELING EFFORT TO INCLUDE: MUD, TAPED, SANDING AND PRIMING. NOTE: THE NEW CEILINGS TO BE FINISHED SIMILAR TO EXISTING OR AS DETERMINED BY THE COMPANY. KITCHEN: APPLIANCES 13. APPLIANCES TO BE SUPPLIED BY THE CUSTOMER,AND/OR QUOTED SEPARATELY UPON REQUEST. IF THE REQUIRED NEW APPLIANCES ARE PURCHASED THROUGH THE COMPANY-RECOMMENDED VENDOR THE CUSTOMER WILL BE PROVIDED WITH THE OPPORTUNITY TO PURCHASE SAID APPLIANCES AT THE COMPANY'S COST. CUSTOMER AGREES TO MANAGE ALL RELEVENT DETAILS PERTAINING TO SAID APPLIANCE ORDER COORDINATE DELIVERY AS REQUIRED BY THE COMPANY. PAINTING 14. INCLUDES ALL PRIMING OF NEWLY INSTALLED DRYWALL. (EXCEPT AS PREVIOUSLY NOTED) ALL OTHER PAINTING, STAINING AND/OR PREPARATION TO BE COMPLETED BY THE CUSTOMER OR WILL BE QUOTED SEPARATELY UPON REQUEST. LEAD AND/OR ASBESTOS TESTING: 15. THE COMPANY WILL PERFORM THE NECESSARY TESTING AS REQUIRED BY THE CURRENT EPA REGULATIONS. SHOULD THE NEED FOR REMOVAL BECOME NECESSARY THE COMPANY WILL PROVIDE A QUOTE. PLANS 16. FINAL CONSTRUCTION DRAWINGS, ENDORSED THEREIN, SUPERSEDE ALL CONCEPTUAL DRAWINGS GENERATED DURING THE DESIGN PROCESS. DEBRIS REMOVAL 17. INCLUDES REMOVAL OF ALL DEBRIS GENERATED AS A RESULT OF THE RENOVATIONS DESCRIBED ABOVE. BUILDING PERMITS 18. INCLUDES THE BUILDING, ELECTRICAL AND PLUMBING PERMITS FEE AND APPLICATION THEREOF EXCEPT AS NOTED. NOTE: SURVEY AND/OR CERTIFIED PLOT PLANS, ZONING BOARD, AND/OR CONSERVATION COMMISSION APPLICATION(S)EFFORT TO BE QUOTED SEPARATELY UPON REQUEST. 3 FREDO PROPOSAL FEATURES S/12/11 PRODUCT SUBSTITUTIONS SUBSTITUTIONS OF ANY AND/OR ALL SPECIFIED PRODUCTS WITHIN THIS AGREEMENT MAY BE EXCHANGED OR SUBSTITED BASED UPON A SIMILAR PRODUCT(IN VALUE),AS DETERMINED BY THE COMPANY.ANY EARNED CREDIT,OR ADDITIONS WILL BE IN ACCORDANCE WITH THE SAID REVISION THE AFOREMENTIONED PROPOSAL FEATURES ARE HEREBY AGREED TO BETWEEN THE PARTIES AND AS SUCH ARE CONSIDERED TO REPRESENT THE ENTIRE SCOPE OF WORK TO BE PERFORMED,AND FURTHERMORE THE PARTIES AGREE THAT SAID SCOPE OF WORK 1S COVETED AND SUBJECT TO ALL THE TERMS AND CONDITIONS AND PROVISIONS SET FORTH WITHIN THE PURCHASE AGREEMENT DATED AUGUST 12,2011. NOTE:THE PARTIED FURTHER AGREE THAT THERE ARE FOUR(4)PAGES (INCLUDING THIS ONE)OF PROPOSAL FEATURES REPRESENTED WITHIN THIS AGREEMENT AS DATED BELOW. SIGNED: DATE P PRINTED NAME SIGNED: ' ,� DATE PRINTED NAME COMPANY P NTA IV . SIGNED: d DATE �� PRINTED NAME_ ilV Y� 1 TOTAL PURCHASE AGREEMENT PRICE:$90,936.00 4 aniteb 9tates Environmentat Protertion Agrurg D s r Da industries oardwalf� orth v has fulfilled the requirements of the Toubstan o ec ' 402,an received certification to conduct lead- based paint re�tion,re t to R Part 745.89 uxts � � PR(x All EPA Administered States,Tribes, and Territories This certification is valid from the date of issuance and expires May 1, 201 NAT-29503-1 Certification# JAir,D sr4 Michelle Price, Chief April 17, 2010 �� 0 Yz Lead, Heavy Metals, and Inorganics Branch 55 Issued On °z Q - -- :a�- - - - - A DATE(MMtDDNYYY) ACM�. INSURANCE BINDER 1 05/23/2011 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN 014 THE REVERSE SIDE OF THIS FORM. ......................................... ................ ....................... ........................... ........... ..... I...................I......................................... ........­­.......... .............. 11,. � -.............. ............... AGENCY COMPANY BINDER# Lakeside Insurance Agency, Inc. Peerless Insurance iB11052322212 ..........................I............................­.­............................... ................-.1.............I..................... ...... ......... ............I................. EXPIRATION Three Wall Street -1 E F F E C T.IV I E..................11MI DATE TIME ............................... ................ Windham, NH 03087 XAM X 12-01 AM 12:01 07/0 06/01/2011 1/2011 PM .................. ..................... ................... .................. ........................................... .. ..... . NOON .. . ..... ................................................................. ...... ......................... ............. PHONEFAX 03.432.6076 ,,f;03.4:32.3666 ,Wo .(N9,.NR I ................................... ................................................................ ...�........................................................................................ THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: 8110104 SUB CODE: PER EXPIRING POLICY A 4-3*13 DESCRIPTION OF OPERATIONS/VEHICLES PROPERTY(including Location) CUSTOMER ID-9 INSURED finder Expires Upon Receipt of Policy Data industries, Inc. Estimated Annual Umbrella Premium - $2991 dba Boardwalk North 24 Orchard View Drive Londonderry, NH 03053 COVERAGES LIMITS TYPE OF INSURANCE COVERAGEIFORMS N:DUCTIBLE COINS% AMOUNT ............................ ................ ...................................... ................................................................................. .................................................. PROPERTY CAUSES OF LOSS BASIC BROAD SPEC ........... ......... ... ................................................... $ GENERAL LIABILITY EA—H OCCURRENCE ............ DAMAGE TO COMMERCIAL GENERAL LIABILITY ',-NTED-FREMISE5.................... p $............................... ............................................... ........... ............. CLAIMS MADE OCCURME D EXP(Anyone ............ ................. ...................... ....................$ :� ......................... PERSONAL....ADV INJURY ...... ....................... GENERAL.AGGREGATE.._ ................ ......................................... ................ ........... .......... ...................... ....................... RETRO DATE FOR CLAIMS MADE: PRODUCTS COMP/OP AGG $ VEHICLE LIABILITY i.pPMqINED SINGLE LIM7 ............i ............................................. BODILY INJURYI(Rer.Pjp!spn) ................ .......... ANY AUTO . ..... ;..PC,P L INJURY.(Pq!,Acqi e 1) .. .................................................... .......... ALL OW14ED AUTOS 1 PROPERTYD ... AG ............................ ............... ......... ................... SCHEDULED AUTOS HIRED AUTOS i-M EDI..CAL..PAYMENTS...............................S ......................... .................. -R 0 AAq Q IN RY,PR T ..S ............ ........................ ................ NON-OWNED AUTOS UNINSURED MOTORIST........................ .............. ASH VEHICLE PHYSICAL DAMAGE DEC) ALL VEHICLES SCHEDULED VEHICLES VALUE,....._.,...; STATED,AMOUNT.............. ............ $ . . ..................... COLLISION: .......... ............ OTHER THARLDL— PA.ACCIPENT ........... GARAGE LIABILITY OHER.T ANALI.T.Q.-ONLY:.............. ....................... ANY AUTO ............. ............................................ ............................... ........................... ............................. ...................... AGGRE ATE 2,000,000 EFIRE K E..................... ............. EXCESS LIABILITY 2,000,000 Xi ............ ............ 8�;.GREGATE........................ ................... ......................................... . ............. , UMBRELLA FORM 10 000 ........... SELF- OTHER TH NUM R LLAF RM RET INSURED RETENTION N W C.S.-ATUTORY11MIT.S . ............................. .. ........................................ T E_EACH ACCIPENI. 3............... WORKER'S COMPENSATION AND ...................................................... EMPLOYER'S LIABILITY LDISEA L. S. ............................-..........I...................... ............ SPECIALTIXE$........................................................ .......... CONDITIONS OTHER ESTIMATED TOTAL PREMIUM COVERAGES & kD ............... MORTGAGEE i........... ADDITIONAL INSURED LOSS..PAYEE .............. .................................. ......... ................. .......... ............ ............................... .................................... � LOAN# ............... .......................... ..................... ........................................... .................... AUTHORIZED REPRESENTATIVE ! Joseph Rossetti/LYNN Page 1 of 2 ACORD CORPORATION 1993-2007. All rights reserves ACORD 75(2007/01) The ACORD name and logo are registered marks of ACORD C 1d f\I�M 1N S V 'RA N C E BINDER _ DCA E(MMIDD/YYY)Y 23/20113/ = 'HIS BINDER IS A TEMPORARY INSURANCE CONTRACT SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. .... ..... . ....... ...... _ ......... . r........ . AGENCY ..__................. .. ....._..._...... _ ..... COMPANY BINDER# Lakeside Insurance Agency, Inc. Netherlands .Lr,s. Co. B11052322213 Three Wall Street .. ....................... DATEEFFEI.C i IVE TIMC EXPIRATION Windham, NH 03087 ._._.-. ___ _._... Dc,TE _TIME............... 06/01/2011 12:01 AM 07/01/2011 X. 12:01 AM PHONE ................ �03 432 3666 pAx _..._......_._._..........._.___.._.._.. PM N 03.432.6076 _...._.._... . _: _...N...... (A1C,No,Ext jA/C,Nu. THIS BINDER IS SUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY ...... _.......__.......... ._,. ...._........._.___... c CODE 8110104 SUB CODE: PER EXPIRING POLICY#: AGENCY ......._...__.....__........._........................,........_._............ __..__.:........._......,......_._._............................. _.. _ 0 0 014 313 ..... ........._...............__..........-..__..._.. CUSTOMER ID: DESCRIPTION OF OPERATIONS/VEHICLES•IF ROPERTY(including Location) INSURED Data Industries, Inc. Binder Expires Upon Rece::pt of Policy dha Boardwalk North Estimated Annual Worker's Comp Premium - $21,994 24 Orchard View Drive Lowidornderry, NH 03053 COVERAGES _ LIMITS TYPF:OF INSURANCE C. _._... CAUSES OF LOSS _._...._.............___,.__.....__.........__..-...,. BASIC BROAD ,.,..•,' SPEC j GENERAL LIABILITY -' EACIIOCCURRENCE : $ ..... ......... _ COMMERCIAL GENERAL LIABILITY DArAAGE TO $ _I REN ED.P.BEMISES.....- ___..._. _..... ... CLAIMS MADE ! OCCUR MED EXP(Any one person) S. ---••- PER:':ONAL 8 ADV INJURY $ .. ...... ..............................................................._......; GENERAL AGGREGATE ;_S RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMP/OP AGG `$ VEHICLE LIABILITY ;.,CQIu1131NED S,INGLE,.LIMIT........_......i..S........................................ .•_, ANY AUTO I,BOUI YINJURY(Perperaon)w_: $ ._ ALL OWNED AUTOS BODI Y INJURY-jPeraccldent).•__S. SCHEDULED AUTOS __._,.. -------------_--• -' HIRED AUTOS i MEDIC-AL PAYMENTS _._.•.__- ,.,S. . . ......... _ ; NON-OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED.MOTORIST `$, I '$ VEHICLE PHYSICAL DAMAGE DED i ALL VEHICLESI SCHEDULED VEHICLES _.: !+CTUAL CAS H_VALUE............ COLLISION: ................................................. .!?TATED,AMO.UNT..._..._.._ $ OTHER N COL: ............................................. GARAGE LIABILITY A.U.,TC ONLI'_.,EA_A.CC.IDENT...._....$_..._................._........................ ANY AUTO ! 9THER_THAN_AUTO.ONL.Y.:.........................................._.......... ...... _. ._........_....__ ....... _..._.....1 A.CHAC.CIR.E.NT__ ._............._.._.....__.......__....__-_.. AGGREGATE EXCESS LIABILITY EACH,O.CCURRE..NCE.........._...............:. UMBRELLA FORM .AGGREGAT.E............................._. .. $. _ . ............ OTHER THAN UMBRELLA FORM RETRO DATE FOR LAIMSS MADE, I SELF•INSURED RETENTION $ X._WC_STAT.UTORY.LIMIT.S.....i..................... .............__....._..... WORKER'S COMPENSATION I 500,000 AND E.1 CACH,ACCIDENT,,,,,,• $, EMPLOYER'S LIABILITY E.I. rISEASE EA EMPLOYEE ._$., 500,000 i E.L.E 500,000 SPECIALF.EE:.............................._..................__......_........;.5..-.__......._. ............................,. CONDITIONS OTHER ;..TAXE:S._......._.._....__..,.................._........_... ...5........... ... ._........._._.__......,... COVERAGES ESTIMATED TOTAL PREMIUM r I ' MORTGAGEE ADDITIONAL INSURED ...........I ILOSS.P.AY.EE......_...............:..... ....................... ...................... ..... ........._..._.........................._..._...............-......._.............. I LOAN# _....._ __._,,.._....................,.._._. _........ __._..._......._......_....... ..... ............................. .__..........__..... AUTHORIZED REPRESENTATIVE Joseph Rossetti/LYNN Page 1 of 2 ©ACORD CORPORATION 1993-2007. All rights reserved. ACORD 76(2007/01) The ACORD name and logo are registered marks of ACORD Massachusetts- Department of Publid Safely Board of Building Regulations and St�ndards QanstruCt"Supervisor LicenS4 F;f3RIAN Lts1RD 'AR"NI 1 f 4 DERRY. NI#,-Pmof t Ga � A. Expiration; 3/14P2013 (ummirswwei Tr#: 103316 7 IC e eo"M�M%" 114@ a 10 Park Plaza - Suite 5.170 Boston, Massachusetts 02116 N0 Home Improvement Coutractor Registration. V?9 ?� c� 10 Registration: 161542 _ Type: Private Corporation Expiration: '10/27/2012 TO 206442 DATA INDUSTRIES,INC.; -- ..-� ✓ r — EDWARD STEWART - ro 24 ORCHARD VIEW DR. LONDERRY, NH 03053 ly OM1. — � pdate Address and return card.Mark reason for change. Address [] Renewal (� Employment [] Lost Card DPS-CAI 0 501VI-04/040101216 LIC' j I. _ ... •. stio 'eu��(or �atW.fnr iadividul_use only .... .... .. ..._ ....- . Officac before the expiration date.I If found return to: HOME IMPROVEMENT CONTRACTOR; Type. Office of Consumer Affairs and"Business Regula ion Registration: 161542 10I Park Plaza-Suite 5.170 Expiration: x/27/2012 Private Corporation . Boston,MA 02116 j ,' :� V'INIUSTR 1 _`_=^ ,(( ,I EDWARD STE LAv 24 ORCHARD VI .= J Not LONDERRY,NH 05 __=� ;'/' Uodersecretary FX k_ I I �j j - I j 'i j I ' I i i i f 1 , j M �