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HomeMy WebLinkAboutBuilding Permit #495 - 120 WATER STREET 2/8/2008 - BUILDING PERMIT r10RTly o�,1"Dq• TOWN OF NORTH ANDOVER a� '` ,_•`..=6 oL APPLICATION FOR PLAN EXAMINATION v< ea Permit NO: J Date Received AL' P p�RATED 9SSgc►+us�� Date Issued: IMPORTANT:Applicant must complete all items on this page o LOCATION. ` : 1., = a r �e Print PROPERTY OWNER - Print. MAP NO PARCEL. ZONING DISTRICT: - _Historic District e x o lMachine Shop Villages ems' no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial epair replacement Assessory Bldg Others: emolitio Other 5epf c Well _rFloodpia ri Wetlands Watershed District Wafer/Sewer DESCRIPTIgN OF WORK TO BE PREFORMED: H Ci ti— R.Q 0 v% k N S k'1 c yt-- (S a's 'e c.► ty2oA�5 F Z6 ta C*3 ikYA`..why Identification Please Type or Print Clearly) IJ OWNER: Name:1 \IS;s�wQov-cr-K Phone: \c -\oZS- �3�� Address: SQ b0 7 'v 0-L-k CONTRACTOR :Name: is Phone: Address: Supervisor's Construction License: : Exp. Date- -"O: w 1=1ome Improvement License:. 1 uS0, Exp, Date: Off' ARCHITECT/ENGINEER 8 v YL-7 - Hi I _ Phone: Z-- 02-u0 . Address: `a D 0 a N e-KZ-13 Z; � 9-aSro-f i'16 Reg. No. ( 0 0 0 FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1- 4-, 00D - FEE: $ 2, g Check No.: 334"1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund P F nature of-A ent O�rrrrer "'- - `'� :-Signature of contractor i 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS I i 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster`on site yes . '.. no A Located at 124 Main Street' " a Fire_Department signatureldate _ A i ° coMMENrs 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) r i ❑ Notified for pickup - Date _.—_......................._................................_......................................................_.__.............._.._..._......._......................................................................................................................_..............._..................._............................................................................................_............................---.._._............ Doc.Building Permit Revised 2007 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 Application Permit A lication ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work i ❑ 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/Crossection/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 j New Construction (Single and Two Family) I; ❑ 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 i NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 I Revised 2.2007 Location No. � Date 2 A 40RTM TOWN OF NORTH ANDOVER 9 « ; . Certificate of Occupancy $ Building/Frame Permit Fee $ ms`s sACHUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2096 wilding Inspector 1 2 v EAST MILL CORRIDOR WORK SECOND AND THIRD FLOORS A 3A 3 s 1A 11 32 1 33 34 2 12 12A N 9A 9 44E 44W, 1 KePlan - Corridor Work Second Floor 1/16" = 1'-0" B 3A 3 1A 11 321 33 34 2 12 12A (3N 9A 9 44E 44W C T_" Plan - Corridor Work Third Floor 1/1 6" = 1'-0" 01,4 o j � � � r117 � . � � IL 1, 02/1 Issued Drawing Number Project Issued 02/19/08 CS 01 ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING N d R T H A N D © V 6 R February 19, 303 Congress Street 6th Floor Boston, MA 02210 Scale Project No. 2008 1/16"=1'-0" 07804.00 Rc���c TEL: 617 423 4252 FAX: 617 423 4333 ©BURT HILL INC. tis 2.1 4 2 3'-0" 6'-0" \Szo Aq�� S. ���► �o.�ooeo / WM S.C.WOOD DOOR TO / \ S.C.WOOD DOOR TO NEWOU MASS. y / MATCH EXISTING / \ MATCH EXISTING 0 0 TYPE A TYPE B T-4" L 6'-4" 2"WELDED 16GA. 2"WELDED 16GA, STEEL WITH ITEGRAL STEEL WITH ITEGRAL STOP TO MATCH STOP TO MATCH N EXISTING N EXISTING ti TYPE 1 TYPE 2 DOOR AND FRAME TYPES 1 1/4" = 1'-0 PARTITION SCHEDULE B PARTITION TYPES TYPE NOTES A EXTEND TO DECK ABOVE 3 518"MTL.STUDS @ 12"O.C. LOz 1 LAYER OF 518"GWB EA.SIDE 31/2"SOUND INSULATION WHERE NOTED SYMBOLS _ = EXISTING PARTITION TO BE REMOVED ROOM NAME ROOM NAME 101 ROOM NUMBER EXISTING DOOR AND FRAME TO BE REMOVED A2 PARTITION TAG SEE A003 NEW DOOR 1O KEYNOTE C EXISTING DOOR TO REMAIN A 1 DOOR TAG HARDWARE SET N0. FRAME TYPE NEW PARTITION DOOR TYPE EXISTING PARTITION TO REMAIN EXISTING BRICK WALL TO REMAIN f Sheet Issued Drawing Number Project Issued `" 02/14/08 A 001 ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING N 0 R T H A N D d V E R February 19, 303Congress Street 6th Floor Boston, MA 02210 Scale Project No. 2008 07804.00 RCG LLC TEL: 617 423 4252 FAX: 617 423 4333 ©BURT HIL.L.INC. As indicated ,r-,211 1 2 .. t j No.10W o *WBURYPOAT IIIASS. a s i A o II j o , I I � I I; �. B - I I� L� I � i i I) -moi , SECOND FLOOR DEMOLITION PLAN B L._.J P r—r� Sheet Issued Drawing Number EAST M'd HIE, Project Issued 02/14/08 A 100 ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING IN O R 7 H A N D 0 V E R February 19, 303 Congress Street 6th Floor Boston, MA 02210 Scale Project No. Zoos 07804.00 ' RcG LLC � TEL: 617 423 4252 " FAX: 617 423 4333 ©BURT HILL INC. ,u 2.1 1 2 , D Aq�� Na 10050 VIM. 11 El 0 X11{0 S�` A i ff I x ® - 0 El � B El I I I r i I � o ID � - _�� I ----------- Q - 9 I� I� 1 r IrNp THIRD FLOOR DEMOLITION PLAN Oil BU R T ? M I 1, L Sheet Issued Drawing Number Project Issued 02/14/08 A 101 ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING N Q R T H A N DO v E R February 19, 303 Congress Street 6th Floor Boston, MA 02210 Scale Project No. 2008 07804.00 RcG LLC TEL: 617 423 4252 FAX: 617 423 4333 0 BURT HILL INC. 1/8°=1'o" vs 2.1 1 2 . SZ�pE�qR�i ft 10M Puss. I ss i ' i J i A 0 CN Q � li A i B I , 47 I I I I i A i I 3'-0" B 2 r, i � I ff C I i ..._ LL- SECOND FLOOR PLAN Sheet Issued Drawing Number r,13 LT , H I L ., Project Issued R T 02/14/08 A 200 ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING N o R T M A N D o v E R February 19, 303 Congress Street 6th Floor Boston, MA 02210 Scale Project No. 2008 RCS LLC TEL: 617 423 4252 FAX: 617 423 4333 ©BURT HILL INC. 1/8"=1'-0° 07804.00 tis 2.1 NO.10M NEWBUC13 RVW MASS. A .......... .........................------- . ................ L -------------- B ALIGN A200 SECOND FLOOR PLAN 1/811 = 1'-0" Sheet Issued Drawing Number B R�- 'T. 1 1, E Easy li�' 0 L E Project Issued ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING 02/18/08 A 201. N 0 R T H A N D 0 V E R February 19, 303 2008 Congress Street 6th Floor Boston, MA 02210 Scale Project No. RCG LLC TEL: 617 423 4252 FAX: 617 423 4333@BURT HILL INC, 1/8"=1 1-01, 07804.00 vs 2.1 DA S. W low *"=*Rl A El E) E) A A ............... El El ID 13 FA] 6"MIN. A U C .......... 1E .. ......................... 9 1 F( 7(c THIRD FLOOR PLAN U off Sheet Issued Drawing Number Project Issued 02/14/08 A 202 ARCHITECTURE ENGINEERING INTERIOR DESIGN LANDSCAPE MASTERPLANNING IN 0 R T H A N D 0 V �E R February 19, 303 Congress Street 6th Floor Boston, MA 02210 Scale Project No. 2008 07804.00 RCS LLC TEL: 617 423 4252 FAX: 617 423 4333, BURT HILL INC. 1/8"=1'-0" v 21 tt0RT-_"%A Town of Andover 0 VO No. 419x- -__ _ 0 dover, Mass., LAKE -$k COC M ICHEWIC 0RA T E D BOARD OF HEALTH Food/.Kitchen .PERMIT T D Septic System 1.. .. ..... .. l BUILDING INSPECTOR CERTIFIES THAT..........I.V0. ... .....4.Mlddb- N1IIS Ali' ....................................................................................................... Foundation has permission to erect......................................... buildings on.. :.S ..................................... ................ .............:..................... Rough Chimney to be occupied as.... ... .................. ......... provided that the person accepting this permit shall in every respect conform to thdterms of the application on file in Final 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 J, ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ........................................... Service BUILDING INSPEC TO]k�`, Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — DG Not, Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. CHANGE ORDER RCG North An to: RCG North Andover Mills LLC s David Steinbergh RCG Builders LLC -Skip Rose East Mill Change Order Number.- 21 umber:21 High Street North Andover,MA Initiation Date; 25-Feb4)8 Architect's Project No.: NAMA000 CG North Andover Mills LLC Contract For: Lobby Renovations T0: t R]7 Ivaloo street �C8ntC8CtOr� Somerville,MA 07143 I Phase: -Common Area improvements/Sitework L, J Contract Date: 12-Jul-07 You arc directed to make the following changes in this contract as a result of approved Change Estimates: CE# Date Approved DESCRIPTION Amount Provide Common Area Corridors on 2nd&3rd Floors-Buildings 1&3 1 2252008 Demolition $4,000.00 1 2125/2008 GWB Framing $9,500.00 I 225/2008 Tape&Paint $4,000.00 i 2/152008 Mise.Wectncal work $1,500.00 I 225/2008 Mise.Sprinkler work $2,000.00 1 2/252008 New Carpet and Bele $3,000.00 Total; $24,000.00 Total AIA Change Order Amount: $24,000.00 The original Stipulated Sum was $184,320.00 The tier chane by previously authorized Change Orders ']'he Stipulated Sum prior to this Change Order was $184,320.00 The Stipulated Sum will be increasedby this Change Order $24,000.00 The new Stipulated Sum including this Change Order will be 5208,320.00 The Contract Time will he unchanged ( )days RCG North Andover Mills LLC RCG Builders LLC OWNER CONTRACTOR 17 Ivaloo Street 17 Ivaloo Street Address _ _ .... Address Somerville,MA 02143 Somerville,MA 02143 BY ,�VP DATE 4!/2-3- 0 DATE 2125/2008 I i NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUS'T'RIAL ACCIDENTS 600 Washington Street,Boston, Massachusetts 02111 617-7274900 As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that Z(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED EMPLOYERS INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE P.O.BOX 4070 BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY WCC 5005531012007 05/10/2007 - 05/10/2008 POLICY NUMBER EFFECTIVE DATES 24 Federal Street 4th Floor Boston Insurance Brokerage Inc Boston,MA 02110 (617)556-7000 NAME OF INSURANCE AGENT ADDRESS PHONE RCG Builders LLC 17 lvaloo Street-Suite 100 Somerville,MA 02143 EMPLOYER ADDRESS y' V\' 03/19/2007 EMPLOYER'S WORI{ERS 'OMPENSATIONV OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonabir hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and rewmnably connected to the work related injury_ In cages requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO DE POSTED BY EMPLOYER. i � o� ✓Zai i I Board of Building Regulations and Standards Construction Supervisor License License: CS 66334 i Birthdate-9/26/1956 �cpratf 009 Tr# 3960 i I l es_#rI =©lex KIERAN T WHEUA'N-- * : °\ 31 RICHMOND i WEYMOUTH,MA 02186` Commissioner lFa ial, BUILDERS RCG BuOdkcr& s u'A q !,=402143 T 617 625 831 F 617 625,F,345 SCHEDULE OF VALUES ADDITIONAL COMMON AREA WORK AT EAST MILL AUTHORIZED FEBRUARY 20, 2008 Description Estimated Amount Demolition $4,000.00 Framing new corridor walls, incl. gypsum board on $9,500.00 one side and installing doors& hardware Tape and paint new walls $4,000.00 Furnish and install new carpet $3,000.00 Miscellaneous electrical $1,500.00 Miscellaneous sprinkler $2,000.00 Total Project Value $24,000.00 Permit Fee ($12.00 per$1,000.00) $288.00 Signatures Owner Contractor Signat e l Signature �Av vl T�Q h1 ` r Printed Name and itle o t.r i'1.a f s i L(- Printed Name and Title 1 B U I- T H I L L 303 Congress Street-6th floor tel: 617-423-4252 Boston,MA 02210 fax: 617-423-4333 www.burthill.com TRANSMITTAL From: Linda Smiley February 20, 2008 To: cc: ------.-.. - -- -----------............................. --- --......_-.._._. .----...._.............-....._........ ------------- Gerald Brown David Steinbergh Inspector of Buildings RCG LLC Town of North Andover Via email 1600 Osgood Street North Andover, MA 01845 Subject/Project Number: NAM Interiors Burt Hill Project 07804.02 Shipping Method: USPS ® Enclosed ❑ Under Separate Cover We are sending you the following - - ----- ❑ Bid Documents 11 Prints El Specifications 1. .....- --- ❑ Corres ondence ❑ Reproducibles ® Other Quantity Drawing Number Date Description ----- -- ._.... ..... .......- 1 2-21-08 Signed and Notarized Affidavit for East Mills, Corridor work for 2nd floor, Building 1 and 3rd floor Building lA Comments: c\docurne--1\del0uri1)\10c01s---1\,,temp\notesf2e$1\transmittal for affidavit 02.21-08.doc - Page l of l OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 07804.02 PROJECT TITLE: Corridor work - 2nd Floor Bldg 1, Third Floor Bldg 1A PROJECT LOCATION:High Street, North Andover, MA NAME OF BUILDING: East Mill, North Andover NATURE OF PROJECT: Tenant separation corridor work IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, 1, Linda Smiley REGISTRATION NO. 10080 BEING A REGISTERED PROFESSIONAL ENGINEERIARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL ® STRUCTURAL ❑ MECHANICAL FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER(SPECIFY). FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become,generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION.116.2 .2 I SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR O01GNAgTUPANG S4' RE SUBSCRI SWD AND SWORN TO BEFORE ME THIS 2-1 DAY OF NOTARY PUBLIC MY COMMISSION EXPIRES�oZd/ / ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 8 PRODUCER (978)356-5511 FAX: (978)356-0214 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bernard M. Sullivan Insurance en ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 Market St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 568 Ipswich MA 01938 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Essex Insurance Co. XSB003 RCG Builders, LLC, DBA: C/O RCG LLC INSURER B: 17 Ivaloo Street INSURER C: INSURER D: Somerville MA 02143 INSURER E: QVERAGES 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. GREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'L POLICTYPE OF INSURANCE POLICY NUMBER DATE YMM/DDTIVE DAE EXPIRATION LIMITS I GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea RENTEDE TO occurrence)rrence $ 50,000 A CLAIMS MADE ❑X OCCUR 3CW6956 3/30/2007 3/30/2008 MED EXP An one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA A $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATUS OTH- EMPLOYERS'LIABILITY TORV LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE North Andover Town Offices EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 120 Main St 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT North Andover, MA 01845 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - J Lewis, Acct. Exec./ ACORD 25(2001108) ©ACORD CORPORATION 1988 IrJCA9r.inn no.. Pnnc 1 of�)