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HomeMy WebLinkAboutBuilding Permit #402-16 - 1216 SALEM STREET 9/30/2015 SOAW,VCT> 9/` �� BUILDING PERMIT QNORTH �,(t�,ED r6 16 �•�� TOWN OF NORTH ANDOVER 32 h APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received rED Fr"�•c5 .sSgcHus� Date Issued: IMPORTANT: Applicant must complete all items on this page r, �r �. � r Lay yz r '�• :A 5 4a VcTr - LOCATION �, sff �_ Mawr r If r , tr 1� ryrrxty " `r �rt`+kt rt"t,° '�" Ati; � "�J'x. �� r \ r '��*'°� �P t.`r; ^iM1';, I Pf � �rt� ti4'�' •.c��9 ya,�.t r�r ~ � +s� 1 G '� .���W t� 1.� ���T,;.�'c �r14� ��•��rSPnnt .� "!+ c- �s=�' F t iti� �� mil�sY„ ,�.�r3d .;.,��- s ,�, s FR0PERT�YYOWNER' no MAP r PARCEL f E ;ZONING ®ISTRICT " Hstonc ®istnct � kyesA` n , . F .� �::r • . , _ . '.�, ` �: z.. �. yx, 'x `Yx ... .` �, MaelineShopVillage�, YeS y n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑ Iteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: --K'Demolition ❑.Other. S¢�ptRr ❑ Wel " ® FI:oodp'la n1 jkWetYands� ��® �, ater�'hed19® riot - DESCRIPTION OF WORK TO BE PERFORMED: Oyql f Ty tUt co` JVb Iden ficat7PleasyTyp- e or Print Clearly �+ OWNER: Name: Cr oS�` �� Phone: ' Address: + 2 It, SOJ&n ., • rr-r.f AAnnF '' �'gL'r i f ��•' �v i� s ,�J f�9 � ContractorNamer gPhone , x�,7� ��m a I I tea,.�.�.tet'=4 r �.��x�»`�;.n.:t3n�tr�'.'� ��Fz�. -�.� '� r i���*2�.a� �- a��.....�,'t.•.�. � �.,� a r� r t= w ,� .� v F; sC k:� r« t v'-•, `i. s-st � R'1"�,°j+`R"e+r7g'.`',`�R4t ,,;' f...4 .; r. * �'ar�i A� '�`��,�' �-yst.r.�y}����,�•yF,' i ' ,? 3. .t� +cam za Supervisors.ConstructionLicense f`I `. �a�yR3� � Exp. ®ate �3�� at ,,� -��+�.,�� a •, ,� ,„ Vii: ,�r� �{'� gar ,��� = �„ r �,.�,` � a�{� �z5��, ,„�''�' �,�s ��„` ,t��,c�,, t s T z 0� v4 ARCH ITECT/ENGINEER�I_�''� Phone: Address: Reg. No. FEE SCHEDULE,BULDINGPY MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED JS' T BASED ON$925.00 PER S.F. Total Project Cost: $ � FEE: $ 13 ✓ho 4. Check No.: 5'79b�2 q 23� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t uaran n.T � ; 3 aA �jq Plans Submitted ❑ flans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ i Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS -iIEALTW Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision:. ` Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW Town Engineer: Signature: Located . 384 Osgood Street FIRE DEPARTIBIIENT - Temp ®urnpster on situ yE�SKI Located at 1►24 Main Street A °— .�"" �`k* • Fire Departnien si,g . ture/date � C� MMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Motor 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.$10041000 fine NOTES and DATA-- (For department use) i i '. II I II i ® Notified for pickup Call Email I Date Time Contact Name i 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Per-mit-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 2012 IECC Energy code w Engineering Affidavits for Engineered products OTE: 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 \2—Ay No. 02-- ^o I (o Date TOWN OF NORTH ANDOVER Certificate of Occupancy $-i Building/Frame Permit Fee $ Foundation Permit Fee $ ~ Other Permit Fee $ ' TOTAL $ Check 9 4 3 Building Inspector NORTH Town of O 0 Z by rM o� ve , ass, 21b COC"ICNf WKN y1. OF x.95 RgTEO �`Pa,��(5 U BOARD OF HEALTH Food/Kitchen PER IL D j Septic System THIS CERTIFIES THATT ,,, , , . ,10 fj BUILDING INSPECTOR . .. .. .. .... � �� �� has permission to erect ............. 'buildings on ... Foundation. .. Rough tobe occupied as ....... ... .. .. ........�.......�. W!+. ............................................ 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 N H ELECTRICAL INSPECTOR UNLESS CONSTRUCT S 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. 8010290169 RR Donnelley 02013.All rights reserved.—0667 mom CONTRACT# 0 00074 MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOWE'S AUTHORIZED RERJEESENTATIV• NUMBER CUSTOMER/l � j STORE NO. STREET ADDRESS STREET ADDRESS k CITY STATE ZIP CITY STATE ZIP �r r Jed C TELEPHONE TELEPHONE t KREG DATE LOWE'S HOME CENTERS,LLC'S MA HIC NO.: 148688 CASH CARO LCC CHARGE FEIN:56-0748358 !X This is only a quote for merchandise and services printed-below. This becomes an agreement upon,payment.Upon.payment,the entire agreement,including the specifically completed pages of'fhis' +t document;the Terms and Conditions included with this document and any:other addenda and attachments hereto„shall be-referred to"herein as this"Contract." PLEASE"READ ALL TERMS;AND CONDITIONS.ON THE REVERSE SfbE-OF THIS'•PAGE.AND FOLLOWING PAGES BEFORE SIGNING. p INSTALLATION STREET ADDRESS CITY STATE ZIP P15 I 2 �+ tsr` r�r y . , Lb I cr- NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. 9yo Contract Total Are permits required for this installation?: gi Yes [ l No *applicable tax included w 00 NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation-activity to be performed In Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order must be completed and signed by the customer for any additional charges. Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising, publicity, illustration,training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left]. Work is to cotlmen e u on reasonable availability of Contractor and/or any special order o/cus Omer made Good(s)which is anticipated to be /,Q2 W1/ [fill in date].Estimated completion date is Xlw /t [fill in date]. Said estimated substantial completion date is not oft e esse ce. A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: 1,6-Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)”Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. Aa•occnnCttr GnQ rl AIMS COVERED BY M.G.L.c.142A This is only a quote for the merchandise and services printed below. This becomes an;agreement upon payment. Upon.payment,the entire agreement including-the specifically completed pages of this docutnent;'the Terms and Conditions included with this document and any other addenda and attachments hereto,'shall be referred to herein as this"Contract." cr .PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CITY S/TATE ZIP ` .o VSD tl•t' f v i'` '�'r_ � t�� 1 Y G` i-aT Al ltJr t`' n. Rf i r iu�r NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based oa the amount of Goods required to fulfill the Contract(including waste).. By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which.may not be refunded once the Installation Services are performed. Contract Total Are permits required for this installation?: J Yes [ J No *applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted woodis discovered during installation additional charges will apply. You will be given a quote and'a change order must be completed and signed by the customer for any additional charges. --- .- . Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide, in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to, marketing, advertising, publicity, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left]. Work is to coetnde upon reasonable availability of Contractor and/or any special order o'cus Omer made Good(s)which is anticipated to be . ® � 1 [fill in date]. Estimated completion date is 1 [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: P[ 1 Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: 1)Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A LOWE'S AND OWNER HEREBY MUTUALL AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH,D&U�E T PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE fOF_Q0VSUME TFAI S D BUSINESS REGULATIONS AND THE OWNERS ALL E REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PRO-Tc IN M.G .1 2 ✓ By: Date: A Low 'siom GerS�e`f; L By: : hy' `f _ Date: Owner Sitgna'fure THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED.ON THE REVERSE SIDE OF THIS PAGE AND THE OLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, NDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVIERSE SIDE CfSF THIS P E AND THE FOLLOWING PAGES OF THIS CONTRACT. YOU ARE ENTITLED TO A COPY O THIS CONTRA II AT THE IMJz-Of SIGNATE. /, s r WITNESS OUR HAND(S) taD SEALS BELOW THIS DA O� r v Lowe's-Home t rs, LL/C ILII Lowe's A'iTthorized Re res�'n fve Owner tJ� J " Co-owner or Witness Customer acknowledges receipt bf a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. 55102 REV. 12/13 FILE COPY ©2004 by.Lowe's.®Lowe's and the gable design are registered trademarks of LF Corporation. c� I !/LLS c4in7L? unweUsen Vf IrlusJ Department of Industrial Ac idents I U�Jlce of investigation Congress Street, Suite 00 € Boston, 111A 02114-2017 >:vw►v massgov/dia Workers' Com 'ensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apolicant information ( Please Print Le ably Name (Business/Organization/individual): t! 1!, ei Dille I i Address: Jr f City/State/Zip: Slaletri. (} D 1.g7 0. Phone 4: 17�- 536-717f Are you an employer? Check the appropriate box: } Type of project(required): 1.❑ l am a employer w4l, 4.1❑ 1 am a general contractor}and 1 employees(full and/or part-t.ime). * have hired the sub-contractors 6. ❑ New construction 2. 1 ain a sole proprietor orI listed on the attached sheet. 7. ❑ Remodeling partner- shipand have no em to ees I These sub-contractors have p y � � $. E] Demolition working for me in any capacity. employees and have wor ers' j { $ 9. ❑ Building addition [No workers' comp, insurance yy comp. insurance. required.] j 5.1® We are a corporation an its 10.❑ Electrical repairs or additions 3.❑ 1 :trt�a homeowner doing all work { I officers have exercised t eir I Ln Plumbing repairs or additions myself. [No workers' comp. I right of exemption per MGL I 12.❑ Roof repairs insurance required.j t c. 152, §1(4);and we have no j employees. [No workers 13.0 Other comp. insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'` must policy information. 'Homeowners who submit this a�ffidavit indicating they are doing all work and then hire outside contractors submit a new affidavit indicating such. Contractors that check this box must attached an additionai sheet showing the name of the sub- ntractors ands tate whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.poli y number. I am an employer that is providing workers'compensation insurance form employees. Below is the policy and job site information. Insurance Company Name: i E Policy#or Self-ins. Lie.#C _ I Expiration Date: Job Site Address: 1216 y� al City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coveragel as required under Section 25A of MGC.c. 152 can lead to the imposition of criminal penalties of a fine tip to S 1,500.00 and/or one-year imprisonment,as well as civil penalties n the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Bead 'ised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb v cern Under 4e Pains and penaMes b er'u that the informi Woninform provided above is true and correct Si nature: -q ' I Date .. Phone#: t 79—5.3�1 '7,f Official use only. Do not write in this area,l to ie completed by city or town officiaL City or Town: i Permit/License# Issuing Authority(circle one): 1.Board of Health 2.(Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other { j C'nntart Percnne ? I i i Phn, o#- CERTIFICATE OF LIABILITY INSURANCE �,yjx� 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER:THIS s; CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POl1C1E$ { NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTFIO I CERTIFICATE OF INSURANCE DOES (S1 RtYED BELOW. THIS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Wlcy(ies)must be endorsed. If SUBROGATION IS WAIVED,sublectto' ' zw 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). PF.ODUCER CONTACT Patricia Guercio Parente Insurance Agency Inc. pN — FAx — Nd.Exc1: 978-531-8854 _ ta,Nor 978-5315587_ 94 Lynn Street E-MAIL arenteinsurance mail.com Peabody MA 01960 ADORES P @9 INSURER(S) AFFORDING COVERAGE NAIC q f _ INSURER A.Atlantic C3sulty Ins CO --- .___. i;NSURED Mike Demille _INSURER e_---..,.____-- _— 5 Bristol Street INSURER C: — — Salem MA 01970-5411 INSURER D; —_-.-- ----._.___---_-----__--- j 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 I !?dDICATED 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_ -- I--w ---"--- —",—._ ' POLICY EFF POLICY EXP !LTR. TYPE OF INSURANCE ? I POLICY NUMBER MMIDD MN!!DD LIMITS COMMERCIAL GENERAL LIABILITY 1 I EACH OCCURRENCE S300,000 _ j r A A } CLAIMS V, OCCURi PREMISES{Ea occurrence; SJ{I,OQQ i L118000742-3 li O8/29I2015108/29/2016 1 MED EXP(Any one person; S 6_,000 i ? PERSONAL&AD'V INJURY S 300+000 ' 1 ! i GENERAL AGGREGATE S 600,000 ` AGGREGATE OOT;APPLIES PER I ----'— A+Po.! ❑ PRO ❑ LGA ; PRooucrs•coMProP AGG s 300,000 I ----- I — � � , ', COMBINED SINGLE LIMIT !$ 1 AUTOMOBILE LIABILITY Ee accident —_—__ Ir ' BODILY INJURY(Per person) $ AUTO r ALL GYJtJED SCHEDULED j I BODILYItv_URY(Pe acc dent)i 5 j AUTOS ��TCS NON OwNEG I PROPERTY DAMAGE 5 --- !PED AL'T O5 AUTOS I ,Per acdderM UMBRELLA LIAR OCCUR I EACH OCCURRENCE LILT i I EXCESS Ll CLAIMS-MADE] ! ! AGGREGATE — S i - :IED RcTENTION S ! � S 7WORKERS COMPENSATION I AND EMPLOYERS'LIABILITY YIN i t FROcR!E'TOR/r,AR-NEP./EXECUTIVE i i jE L EACH ACCIDENT is F tCERWEMBER EXCLUDED' :N/Al + {Mandatory in NH) E.L.DISEASE-EA EMPLOYEC S if yes describe under I DES;;RIPTIGN OF O'rERATiONS below .L.DISEASE-POLICY LIMIT 's ' I DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) 1 {I t i + CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc and any and all subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Vendor Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1111 I N Wilkesboro, NC 28656 AUTHORIZED REPRESENTATIVE I U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Produced using Fomes Boss Web software,www.ForTnsBoss.com;o impressive Publishing 800.208-1977 .x cp i 1� N v � Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, Massachusetts 02116 h Home Improvement Contractor Registration to Registration: 162722 Type_. Individual Expiration: 416/2017 Trtt 264520 MICHAEL THOMAS DEMILLE MICHAEL DEMILLE ` — - 7 5 BRISTOL ST SALEM, MA 01970 ! Update Address and return card.IFiark reason for change. sca 0 2aMasrrt I= Address n Renewal (_] Employment Last Card �Q�namo�crrten/!1e r�"�tfitaurJvecllt free Of Consumer Atrair&&BusinessRego Imano License or registration valid for'individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: "13tration: 162722 Type: 0171ce of Consumer Affairs and Business Regulation piration: _A16+2017 Individual 10 Park Plaza-Suite 51.70 Boston,MA 02116 5 BRISTOL ST — :a-- . 1 SALEM,MA 01970 � _ � _ .. Not valid without signature H 0 ti w v Ci C`d tq EV n C111 i GN 4 - �� ti Cyt t� •, a,'� �»� � Al ION iA VV rr�4 cst' tidig e1 atar�rs. Licernsei CS-082I93 " w