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HomeMy WebLinkAboutBuilding Permit #835-2016 - 1225 SALEM STREET 1/26/2016 NORTI� A611Y 4ALA -�L�- BUILDING PERMIT °F�t�eo 6Aro TOWN OF NORTH ANDOVER 32 y -� .6 ° APPLICATION FOR PLAN EXAMINATION y, / /l� (• A O Permit No#: 1 /(jvj 04 ~ Date Received SSACHUS� Date Issued: 7/ PORTANT: Applicant must complete all items on this page LOCATION _ Pr nt PROPERTY OWNER Ah Ad' '��e►� (/ Print 100 Year Structure yes no MAP PARCEL: b ZONING DISTRICT: _Historic District ye no Machine Shop Village y _ no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: No 2 Identific tion- Pl ase Type or Print Clearly OWNER: Name: �t,T;c�l�r vi f SPY Phone: 1-7-310-360 Address: aZo1 rJ �`�� o n�o vQr V►')� gim- mc Contractor Name: PIe: ` 70� q' Address: _L7 W0,6 6- M( YY1 I 1 Supervisor's Construction License: q 7 Ex Date: Supervi _ p Home Improvement License: 1-71 S6? Exp. Date: I/ L[6 ARCHITECT/ENGINEER N�g 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: $ 5���— FEE. $ 16q— CheckNo.: �_Ucem-m-I) y Receipt No.: , NOTE: Persons contracting ith unregistered contractors do not have ac to the guaranty fund 6ignature of Agent/Owner Signature - contractor ! Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ TYPE'-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 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 Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 to the guaranty fund �-� Si nature of contractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I 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 o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location ,2 2 S P `7- 2-d 1 Date "Z No. �0 . - TOWN OF NORTH ANDOVER • LE 1)j 6` • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check Building Inspector NO R T!1 own of � Andover.. : _. � 0 No. Z ver, Mass, O �Cne SpA cocMIc«ewIcw �.90RATED l U BOARD OF HEALTH i 'I Food/Kitchen C Septic System PER BUILDING INSPECTOR THIS CERTIFIES THAT .....MIT .�. ................ .... . . . Qin......... ....... .................. ................ _ � Foundation ............ buildings on .......�.. .� .. has permission to erect •••• •••rCA • • .ck p ........ g Rough to be occupied as .......� .. �G►Cj..` ... ��..!!! .. . .M!!!�. ..................................... Chimney e provided that the person acceptingis 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 I� Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 WNTH ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTI TAR S 0; o 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 162013.All rights reserved.—0667 1 77 CONTRACT# 000332 s MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT �LOJW�E'S�AUTHORIZE3Dy.R—E�PRE�SENTATIVE ,j�LUM0_3 BER O�l+ CUSTOMER�� LORE-)Z STREET ADDRESS \J. l R T-�_ ADDRESSsens CITY STATE ZIP CITY STATE ZIP TELEPHONE PHObIE DATE-7 1 LOWE'S HOME CENTERS,LLC'S MA HIC NO.: 148688 BASH tBANK LCC cHaRGe JC.'Z l FEIN:56-0748358 This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,the entire agreement,including thespecifica ly completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contra" PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS _ CITY STATE ZIP `AkLAa -�t. ��l +cam t4t1( �)AJq tJ A P �'^i U J �` 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 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. Contract Total Are permits required for this installa ' Yes [ ] No *applicable tax included NOTICE TO CUSTOMER: Federal law rde es 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. n NOTE: If rotted wood is discovered during installation additional cha es I p You will be given a quote and a change order must be completed and signed by the customer for any additional c�iarg Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additiions Ill bel41:Sit additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and indepen dent 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]. Worf i to 'mmence upon reasonable availability of Contractor and/or any spe rder r rstomer made Good(s)which is anticipated to be ( [fill in date].Estimated completion date is % 1, _ [fill in date]. Said stimated 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. PLETE TI 111 S 0 ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: ] stomer to PayuD F 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 $ L` 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 AKIM nArnlco uFRFRV 1\111 ITI IAI I Y AGREE IN ADVANCE THAT IN THE EVENT LOWS S HAS A DISPUTE CONCERNING THIS CONTRACT,THA t- 1 This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment.po payor Upon payment,the entire agreement,including the specifica ly completed pages of this 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 SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS � t _ CITY STATE ZIP�1 l f►., (,J - vD11, 1 It.? -eq�rim CO s- f i 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. Contract Total Are permits required for this install � � �' Yes [ ] No *applicable tax included NOTICE TO CUSTOMER: Federal law r`gvi s 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 cha �es�l11' p You will be given a quote and a change order must be completed and signed by the customer for any additional c�iaCustomer must initial. 'Any work or material not specified is not included in this contract.Any changes or additions ill be qt an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and indepen ent 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]. Wor is,to commence upon reasonable availability of Contractor and/or any spe ' rder r customer made Good(s)which is anticipated to be [fill in date].Estimated completion date is [fill in date]. Said stimated 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. PLETE THIS S O >JONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: ] stomer to Pay ip 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 MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBS OT'SUSH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF C©NSUMER FAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS ROWDED IN A/i. �j t By: V I W,_ :" `/" `� Date: 6W �s' oyy� C/ tersL�/% B f1�" 1 %/E.! Date: C)�yner Signature ` Y 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 FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND'CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OAF THIS CONTRACT AT THE TIME OFKSIGNATU,6UE. WITNESS HAND(S)AND SEAL(S)BELOW THIS Z� DAY OF ' owe Home enters, LL ,�j Gam( Lowe' Authorized`'t�epre4entative " O � Co-owner or Witness Customer acknowledgesJreceipt of a true copy of this contract w ch 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'sLowe's and the gable design are registered trademarks of LF Corporation. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - t f 600 Washington Street :r Boston. MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nanie itfusrotss!Orgattii;tlicnt/lndividual}: �O�prl �+ ��t1/ Aciclr+`ss: —7 b 7 U16m fit. City/State/Zip: t Y1 0 Phone#: �(-7 8` 7aq-6V3 Are you an employer? Check the propriate box: Type of project(required): I. I am a employer with 1 _ `. ❑ 1 am a general contractor and 1 cntployccs(full and/or part-time).*- have hired the sub-contractor. (� [] New constnution �.❑ I ant a sole Proprietor or partner_ listed on the attached sheet. 7. ❑ Reniodeling ship and have no employees These suh-contractors have S. ❑ Demolition working for nic in any capacity. employees and have workers' INo workers comp. insurance comp. insurance. g 9. (] Building addition required.► 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions �.❑ i am a homeowner doing all work officers have exercised their l 1.❑ Plumbing repairs or additions nlvscll. No workers' cont right of exemption per MGL p• 12.❑ Roof repairs insurance required.] ' c. 152. §1(4),and we have no employees. INo workers' 13' ]O}the comp.insurance required.) 'Ant eipplicant that checks Itit.e#1 mast also fill out the section Wow showing their workers'compensation policy information. I lomr,m ncrs ss ho submit this alfidae it indicatini:they are doing all work and then hire outside Contractors must submit a new a(fidas it indicating such. 'C'oniractor•than check this box ntttst attached an additional sheet showing the name of the suKcrnuractors and state whether or not(hose entities has e rmhliscc.. if the mil,-contraoor,hasc employees.they must proride their workers'comp.lxilicy numb r. I ant an emplaver that is providing workers. 'connpensation insurance./or my emplavees. Below is the policy and job site. iufornnation. Insurance Company Nanic:�.T. My4vad -T11 S. (yP Vkn ies Policv #or Self-ins. Lic. #:_UCc 50D J5 01 y 0Ft o?O10 Expiration Date: 11 Y I .lob Site Address: �.�.� ���`}'� .5�, City/State/Zip: 01 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of i NGL c. 152 can lead to the;imposition of criminal penalties of a line up to S1.500.O0 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of ftp to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of InvesiiL,ations of the DIA for insurance coverave verification. I do hereby c'ertr'f under the pains and penalties cif perjury that the information provided above is true and correct. .Stn"I7a u—tc �/ Dale: :-0-- Photic#: Official use only. Do not write in this area,to be completed hr city or town official. Cit} or Town: _ PermiULicense#_____ issuing authority(circle one): 1. Hoard of Health 2. building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:_ Phone#: I rnrv)-.Jnhm Wnlsh Inturnncc± 978 745 9557 19/11/9015 tO a0 #570 P 0091009 '+1 9MCNA01 OP ID:MM '� Ro CERTIFICATE OF LIABILITY INSURANCEF77,'211112015 E(S!M:DDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the I certificate holder in lieu Of such endorsemen4s). PRODUCER CONTACT John J Walsh ins Agency,Inc NAME: David C Bruett yPRONE — - - — - ' 'FAX P O Box 4407 (AJC,Ne,E,It}:978-745-3300 Salem, MA 01970-6407 EMAIL -- ---' — - (A c.,Nn): 978-745-9557 David C Bruett ADDRESS dbruett@walshinsurance.com INSURER(S)AFFORDING COVERAGE MAIC a INSURER A:Travelers INSUREO McNary Construction INSURER B_A.LM.Mutual Ins. Companies Joseph McNary -- 767 Woburn Street INSURER C: Wilmington,MA 01887 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: PAIS IS TO CERTIFY THAT T•HL POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD VUICAT D NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TG'NHICH THIS CERTIFICATE MAY BE ISSUED OR %VY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB,IFCT TO A:.l. THE TERMS ACLUS:UNS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IF:SR 'AOOLSUBR .__. .. ._...__._..._...----...- - ------_.__...i-._.. ---. .... . ..._._ ..... ._. .. LTR TYPE OF INSURANCE POLICY EFF POLICY ExP POLICY NUMBER MM/OD/YYYY MWDDIYYYY LIMITS • GENERAL LIABILITY CACIf OCCURRENCE $ 1,000.00 A ct'."!AFR.!:;L ccti[Ftn-L!;.Ea:TY 680-6621 P22A 15 4202108/2015 0210812016 1n�SrS 'n ccc:,r•r.c+1 300,00 tf N1ED 9X1'rA^.y r.c G^r cn S 5,00 X Business Owners 'PERSONAL&ADV INJURY i } 1,000.00 1 GIN=FAL AGGRFC,ATF I} 2,000,00 rt'•+!./„,^,i;i?cGAILLIFAI1APi>;irSPerk PROAJCT$ CUfss-r;,Prr,G F 2,000,00 _— AUTOMOBILE LIABILITY - CCMBLkED S M:;LE Li-- ` (ca a:udortl .___ g 1 VUUILY INXJHY(Ptr rersc;n; ' •�I!.•_':VJ\LC � _. :iC F.F.I'JIIL.F t: --- - .. .... n::C. AL'ICS BODILY INJURY!P,:r ac_,dernt 5 NON-O'WhAD _- IUIeCGAU!OS AL,10q I PROPEfcTYDAlJAGE . Q UMBRELLA LIAB OCCUR � - EXCESSLIABi `_'ACt!:JC'CUFR:NCF ._,/IMi lietiGt' AGGREGATE _. —__-, } (Ji 11 RE IEN 0014 . .. ..... 3 - . WORKFRS COMPENSATION t'1C STATiJ OTH- AND EMPLOYERS LIABILITY Y!N . .TORY LRAIT$;_.__• tk,._ B :,u. ;vl'RI( oR-arttvl_Nrr. CU'nt r'- WCC500501408i-2015A 11114/2015 1111412016 EL EACH At IDENT 500,00 i!;I CL H!t'Eb!UeiR F,'X1,Li10E:%' -N 1 A; (Mandatory m NH) �--`, -.._.._._._._...—.-.---._.... [Mandatory i ) E.1, DISEASE•EA E.'.1PLCYEE_'-S 500,00 tiF SCF?w1�oN O� O%'c1;At:ONS cec.v F 1. DISEASL-POLJCY LIMN S 500,00 PROPERTY 5,84 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Lowe's Companies, Inc and any and all subsidiaries are additional insured with respect to commercial general liabiity. Waiver of subrogation applies per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowe's Companies Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Vendor Insurance PO BOX 1111 AUTHORIZED REPRESENTATIVE N Wilkesboro, NC 28656 <;- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD t#la6sachirsctts-Impartment of Public Safety Buird or Sfillding RegWatlons and Standards Crincirnclirn Srrperniuir License:C"SI974 JOSEPH G MCNAAY 767 WOBURN Sr �3 WJ.11.'MWGTON MA 1� ''IX, Expiration C.�n�missio�tc� O'f118/Z016 tai T� N s r7� � ��. d OfIlct6rCdiatrniera�aBulaeatRegsta8on E NPltO_++EMENT COr� MOTOR FP'©r�- ' Istratlon: `�.7T567 Typo; plraElnn: •1.j�j��S., Individual X) d , cL,y SIri=H G.MCNAi71" ... .. R JOSEFII MCNARY '167 WOHLIRN ST W11-MINGTON,MA 01887 '•��••' . . vbuosassrel.ry