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HomeMy WebLinkAboutBuilding Permit #122-2017 - 124 OLD VILLAGE LANE 8/8/2016 L 0011 1 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �9ss�c►+us�� Date Issued IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER /1/1 ( T1::l4/!i Print MAP NO:-�$—PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building wbne family ❑Aoition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: A 1J0514/-14- Phone: Address: kr> U G , CONTRACTOR Name: Phone: r4rof/J Address: _ r �` all � r Supervisor's Construction License: TT— Exp. Date: -ay( 60 r Home Improvement License: Exp. Date: , 1 ARCHITECT/ENGINEERGx Phone:q? 3 Address: S Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: :EU0a FEE: $ Check No.: Receipt No.:1110� I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �i nature of A ent/OwnerSi nature of contractor �_9 -- - g- ---- -te r �9 �t - -- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ _ e TYPE OF SEWERAGE DISPOSAL �. I, Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimmingpools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING M DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on_ Signature COMMENTS 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 DPW Town Engineer: Signature: Located 384 Osgood Street F € DEPARTMENT"Temp�tDupster on sltex.,yes.;.., � . ,� �„�s�►z'no "` " _ Located at 124rMa n;St`reet +"i .-vr'+�,��`�^L}� - �t. .,� K..,,Z a•.� i .-f,,,� <t �t+'.s� y'C x�c�+.� :� '� t t F.irelDepart�me sf ature/date4>: . Sy. - rer _ � i^r, v ..r. �.� -. {� YZ' a....{:- �rt- 1 " t�i GaY_' '•Y�,''.�"'�tf�¢�-��'t3iew''.'��•� -'s_� s�?"'�+•r s��N. y 4 4 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 droprequires approval q l'p of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building 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 4 Building Permit Application 4. 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 ire sign off from Fire prior to issuance of Bldg Permit Department OTE: All dumpster permits requ g p 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) � Building Permit Application 4 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 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 I must be submitted with the building application s i Doc:Building Permit Revised 2014 ti Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 95'5,000.00 m $ - $ 1,140.00 Plumbing Fee $ 142.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 142.50 Total fees collected $ 1,525.00 124 Old Village Way 122-2017 on 8/8/2016 Kitchen Renovation l OORTH own o t ,F. 6 ndover O .�-. 0 A�° h ver, Mass, X O�f1 coc MICMlwic" 4ATE 12 S U BOARD OF HEALTH Food/Kitchen PERM L D Septic System THIS CERTIFIES THAT q,* .... ......... ,,,.,,,,,...,. BUILDING INSPECTOR .................... ................................ ............... l ... Foundation has permission to erect ....... .................. buildings on .. ... /ri�.... t/ . C....... �jA � Rough tobe occupied as ............I. �R� �...... �.m� /...................................................... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service ... ... . . . . BUILDI INS ECTOR... Fina 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. DAVID GRAHAM CUSTOM BUILDING 66 FEDERAL ST. NEWBURYPORT MA.01 950 HM/FAx 978.462.2183 CELL 978.479.7727 THIS AGREEMENT MADE THE EIGHT DAY OF AUGUST 2016 BY AND BETWEEN, DAVID GRAHAM, HEREINAFTER CALLED THE CONTRACTOR AND MIKE FINA CALLED THE OWNER, ARTICLE 1. SCOPE OF WORK THE CONTRACTOR SHALL FURNISH ALL OF THE MATERIALS AND PERFORM ALL OF THE WORK(SEE KITCHEN PLAN)AS IT PERTAINS TO BE PERFORMED ON PROPERTY AT 124 OLD VILLAGE LANE NORTH ANDOVER , MASS. ARTICLE 2.TIME OF COMPLETION THE WORK TO BE PERFORMED UNDER THIS CONTRACT SHALL BE COMMENCED ON OR BEFORE AUGUST 22ND 2016 AND SHALL BE SUBSTANTIALLY COMPLETED ON OR BEFORE DEC. 15TH 201 6 .THE FOLLOWING CONSTITUTES SUBSTANTIAL COMPLETION OF WORK PURSUANT TO THIS PROPOSAL AND CONTRACT: SEE KITCHEN PLAN. ARTICLE 3.THE CONTRACT PRICE THE OWNER SHALL PAY THE CONTRACTOR FOR THE MATERIAL AND LABOR TO BE PERFORMED UNDER THE CONTRACT THE SUM OF NINETY FIVE THOUSAND AND SIX HUNDRED. .THE EXACT PRICE WILL BE THE TOTAL OF THE ACTUAL COST: ARTICLE 4. PROGRESS PAYMENTS PAYMENTS OF THE CONTRACT PRICE SHALL BE PAID IN THE MANNER FOLLOWING: 5,000 TO START 5,000 AFTER ROUGH FRAME , 5.000 AFTER ROUGH INSPECTIONS 5,000 AFTER PLASTER 5,000 AFTER TILE 5,000 AFTER STAIR REBUILD, 5,000 UPON COMPLETION. PAGE ONE F ARTICLE 5.GENERAL PROVISIONS ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS, INCLUDING BUT NOT LIMITED TO ANY SUCH ALTERATION OR DEVIATION INVOLVING ADDITIONAL MATERIAL AND/OR LABOR COSTS,WILL BE EXECUTED ONLY UPON A WRITTEN ORDER FOR SAME, SIGNED BY OWNER AND CONTRACTOR,AND IF THERE IS ANY CHARGE FOR SUCH ALTERATION OR DEVIATION,THE ADDITIONAL CHARGE WILL BE ADDED TO THE CONTRACT PRICE OF THIS CONTRACT. IF PAYMENT IS NOT MADE WHEN DUE, CONTRACTOR MAY SUSPEND WORK ON THE JOB UNTIL SUCH TIME AS ALL PAYMENTS DUE HAVE BEEN MADE. A FAILURE TO MAKE PAYMENT FOR A PERIOD IN EXCESS OF 10 DAYS FROM THE DUE DATE OF THE PAYMENTS SHALL BE DEEMED A MATERIAL BREACH OF THIS CONTRACT. IN ADDITION,THE FOLLOWING PROVISIONS APPLY: 1. ALL WORK SHALL BE COMPLETED INA WORKMAN-LIKE MANNER IN COMPLIANCE WITH ALL BUILDING CODES AND OTHER APPLICABLE LAWS. 2. THE OWNER SHALL FURNISH A PLAN AND SCALE DRAWING SHOWING THE SHAPE, SIZE DIMENSIONS,AND CONSTRUCTION AND EQUIPMENT SPECIFICATIONS FOR HOME CONSTRUCTION,A DESCRIPTION OF THE WORK TO BE DONE AND DESCRIPTION OF THE MATERIALS TO BE USED AND THE EQUIPMENT TO BE USED OR INSTALLED AND THE AGREE CONSIDERATION FOR THE WORK. 3. TO THE EXTENT REQUIRED BYLAW ALL WORK SHALL BE PERFORMED BY INDIVIDUALS DULY LICENSED,INSURED AND AUTHORIZED BY LAW TO PERFORM SAID WORK. 4. CONTRACTOR MAY AT ITS DISCRETION ENGAGE SUBCONTRACTORS TO PERFORM WORK HEREUNDER, PROVIDED CONTRACTOR SHALL FULLY PAY SAID SUBCONTRACTOR AND IN ALL INSTANCES REMAIN RESPONSIBLE FOR THE PROPER COMPLETION OF THIS CONTRACT. 5 THE CONTRACTOR SHALL.NOT BE RESPONSIBLE FOR THE PROTECTION, OR TO MOVE ANY POSSESSIONS ON THE PREMISES. 6. ALL CHANGE ORDERS SHALL BE IN WRITING AND SIGNED BOTH BY OWNER AND SHALL BE INCORPORATED IN AND BECOME A PART OF THE CONTRACT. 7. CONTRACTOR SHALL OBTAIN ALL PERMITS NECESSARY FOR THE WORK TO BE PERFORMED. 8. CONTRACTOR AGREES TO REMOVE ALL DEBRIS AND LEAVE THE PREMISES IN BROOM CLEAN CONDITION. 9. IN THE EVENT OWNER SHALL FAIL TO PAY ANY PERIODIC OR INSTALLMENT PAYMENT DUE HEREUNDER, CONTRACTOR MAY CEASE WORK WITHOUT BREACH PENDING PAYMENT OR RESOLUTION OF ANY DISPUTE. 1 O.ALL DISPUTES HEREUNDER SHALL BE RESOLVED BY BINDING ARBITRATION IN ACCORDANCE WITH THE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. 1 1 .CONTRACTOR SHALL NOT BE LIABLE FOR ANY DELAY DUE TO CIRCUMSTANCES BEYOND ITS CONTROL INCLUDING, STRIKES, CASUALTY, GENERAL UNAVAILABILITY OF MATERIALS OR PROLONGED INCLEMENT WEATHER. 12.CONTRACTOR WARRANTS ALL WORK FOR A PERIOD OF 12 MONTHS FOLLOWING COMPLETION. PAGE TWO ARTICLE 6.ADDITIONAL TERMS SIGNED THIS DAY AUGUST 8TH 2016 NAME OF OWNER: MIKE FINA SIGNATURE: NAME OF CONTRACTOR: DAVID GRAHAM SIGNATURE: DAVID GRAHAM CUSTOM BUILDING 66 FEDERAL STREET NEWBURYPORT, MA 01950 978.462.2183 CONTRACTOR STATE LICENSE#:CS 046604 HOME IMPROVEMENT"CONTRACTOR#: 103146 PAGE THREE 0 JOSE ��++ F r�► 1j v STR � M °�0 O a » B=v u„BIB C5 0 »lr,BB�BIbb,O � T1.9 C97/J"V6;0-i,33 O ,I � z ; s � (s) CA ZX #29 ##28 #30 C4 32 -425 #24 _ #26 517/8— 110- / y `n �JUl7 �ZT/fj�c� 1'. tlF✓!1/r �P/^v'tEIC #33 O W Mike&Jodi Flna 52 ISI d base 6 #48 Adreoe: #51 #49 #47 124 Old Villa.lane e !mIo o n 6915/16 ga a s ty N Ando er State: MA #1�9 53. #5 Island Base A ---� Revl5ioi'15: 42 #50 a Rev.T A-13-16 xo,rz ei #35 4 °' 46 # #37 Y Y Job Title: #46 # i #44 1651 Fina 7 Pant Date: »Y9 —]56l— »i9 b It vx M E BVB (y)zxG r lT kitchen o-13/10 MO.6y: 1 xn,rs - ,%vx Bbzx Tom 318 1' ”= #X/(P& PCf% Job#: Sheet#: dvE,e L.¢lc�i Cz'LG+ 1/�✓.9 �+4P_.✓� 1651 Sheet 1 Rejected(Ag Notea 0 Approved Signature Date ���v/�� ADVANCED CUSTOM CADINfTS p _ Jose ►�• t Z3 U mo .un— T---_ _>�----:xu.c--e�.----.---...+o:s--_-,. 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[��•1 W � q — —ru.c—__ sr—_ sn•. —s,.—__ nes— I r a- 070 W2-Y-33( Z wcon Q 1-4 s #2e . — a30 i 4 i2 CD #24_ \ #26 > —•51 718 1 CS VPAV OF Omar 11rf$ 1' 1 fdAc 2 Jodi mina s i 152 Is) #d51 hale 49 8 I 048 #47 1 t I _ # `., jj I, 1'1 -.o41rc•Du:,4 01A V;14 ,L,— 74 V4 4 a Pr, Stmt c: MA 53. #5 Island Bose A I �� #50 _ j RBv15IDY15: 11cv.16-13-16 x#41 a'>14 AMIX46VI_ s #39�---- I #37 JDP tirlc: #as -4 #44 \� 1651 Fina -- —— ---- —' - ----_-- -- —— -L kitchen II ,xe eoae �e nrx e.xw no re an. .x,:�,xge VVI i.0y: , xn c: sox my>:, Tom 3/8"=1, 1651 Sheet 1 El Rejected(As Noted) FP�f1,��L ADVAN[kOCUSIOMCAWNF.iS Approved Signature Date +� p U 377 r V M O O O 158 81 5/18 13811/18 17512 3713116 48 3813116 76718 1361/2 38 385/16 51-- 1 365118 777/8 O �-' +.a Z w #29 #2 #30 C V �J M #32 9a H Z l\ s #24 #26 1 O --- LO - #33 W %r P-4 Name: Mike&Jodi Fina 52 Island base B #48 #5 #49 #47 AddreSe: 124 Old Village lane City: 5tate: 0 0 69 15/16 34 Y N Andover MA M / 454 53 #5 Island Base A a2 #50 1�evi5ion5: Rev.16-13-16 30 12 78 42 27 14 1/4 -L 30 88 3/4 ` #35 34 ----------------- - \ #41 #40 # / 35� #37 6 Job title: #46 #45 #44 1651 Fina 7 Print Date: 1 303/8 —75618 30 3/8 38 31 12 1 1 2a 22 1263/8 kitchen 06/13/16 30 3/8 -E 7 53/4— -IE .303/8 3IE 671/2 '!IE 481/23•IE 124 3/8 DWG.BY 217 112 158 3/8 3/8"= 1 ' 378 7/8 Tom Job#: Sheet#: - 1651 Sheet 1 ❑ Rejected / Ao- Noted ) El A roved Signature Date ADVANCEDC.bl -y Sin- 1972 JI nn At— Cabinotry Slnco 1972 p I Andersen. Andersen Windows -Abbreviated Quote Report Andersen Project Name: D GRAHAM Quote#: 136 Print Date: 06/29/2016 Quote Date: 06/29/2016 iQ Version: 16.0 Dealer: Customer: Billing Address: Phone: Fax: Sales Rep: Administrator-DO NOT REMOVE Contact: Created By: Trade ID: Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext. Price 0001 1 CN135(L) $ 374.73 $ 374.73 RO Size=1'9"W x 3'5 3/8" H Unit Size=1'8 1/2"W x 3'4 13/16"H Unit,White/White-Factory Painted, L Handing, High Performance Low-E4 Glass Insect Screen, White Hardware Pack, PSC,Andersen Classic Series-White Zone:Northern U-Factor:0.28, SHGC:0.32, ENERGY STAR®Certified:Yes 0002 1 P5535(F) $ 647.40 $ 647.40 ROSize=5'53/8"Wx3'53/8" H Unit Size=5'4 13/16"Wx 3'4 13/16"H Unit,White/White- Factory Painted, High Performance Low-E4 Glass Zone:Northern U-Factor.0.27, SHGC:0.34, ENERGY STAR®Certified:Yes Quote#: 136 Print Date: 06/29/2016 Page 1 Of 2 iQ Version: 16.0 Andersen. Andersen Windows -Abbreviated Quote Report Andersen Project Name: D GRAHAM w.ww.•...e. wi...w,.o..0 Quote#: 136 Print Date: 06/29/2016 Quote Date: 06/29/2016 iQ Version: 16.0 Dealer: Customer: Billing Address: Phone: Fax: Sales Rep: Administrator-DO NOT REMOVE Contact: Created By: Trade ID: Promotion Code: Item Qty Item Size(Operation) Location Unit Price Ext. Price 0001 1 CN135(L) $ 374.73 $ 374.73 RO Size=1'9"W x 3'5 3/8" H Unit Size=1'8 1/2"W x 3'4 13/16" H Unit,White/White- Factory Painted, L Handing, High Performance Low-E4 Glass Insect Screen, White Hardware Pack, PSC,Andersen Classic Series-White Zone:Northern U-Factor:0.28, SHGC:0.32, ENERGY STAR®Certified:Yes 0002 1 P5535(F) $ 647.40 $ 647.46 RO Size=5'5 3/8"W x 3'5 3/8" H Unit Size=5'4 13/16"W x 3'4 13/16"H Unit,White/White-Factory Painted, High Performance Low-E4 Glass Zone:Northern U-Factor.0.27, SHGC:0.34, ENERGY STAR®Certified:Yes Quote#: 136 Print Date: 06/29/2016 Page 1 Of 2 iQ Version: 16.0 The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPMUTTING AUTHORITY. Aoplicpnt Information b Please Print Legily Name(Business/Organization/Individual): P, -VGci Address: �� L City/State/Zip: f1f5-0 Phone#: '7�` Are you an employer?Check the appropriate box: Type of project(required)' 1.❑I a employer with employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[Ido workers'comp.insurance required]t 9. El Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions prorietors with no employees. 12.E]Plumbing repairs or additions 5. I am a general contractor and I have hired the subcontractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We area corporation and its officers have exercised their right of'exemption per MGL c. 14.E]Other 152,§t(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: i Policy#or Self-ins.Lic.M Expiration Date: i C� j ob Site Address: 49 / akl) City/State/Zip: � l Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ' Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si.nature: ir- c/ Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M GRAHA-4 OP ID:CA ACORO° CERTIFICATE OF LIABILITY INSURANCE DA081081201TE Y) 08/08/2016 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Chase&Lunt LLC NAME: Michael C.Howlett 65 Parker Street aCo No Fact:978-462 3434 A No:978-465-6204 Newburyport,MA 01950 E-MAIL Michael C.Howlett ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Merchants Insurance Group INSURED David Graham Custom Building INSURER B:Safety Insurance 000773 66 Federal Street Newburyport,MA 01950 INSURERC: INSURER D; INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTR TYPE OF INSURANCE INSD POLICY NUMBER MMIDD EFF MMUCDY EXP LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000', CLAIMS-MADE I—XI OCCUR BOP1087046 09/16/2015 09/16/2016 DAMAGE TO REN PREMISES Ea occurrence $ 500;00 X Business Owners MED EXP(Any one person) $ 15,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY 1 JECT PRO- 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY EOMaBBIINdED SINGLE LIMIT $ 1,000,Iffic B ANY AUTO 6235556 10/13/2015 10/13/2016 BODILY INJURY(Per person) $ ALL OWNED �( SCHEDULED Per accident)BODILY INJURY $ AUTOS AUTOS ( X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION 1PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ K es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building Department AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /e ¢a".f Office of Gossamer AffTairairs s&Busilca aj' ?ss�c rnsel3 Massachusetts Department of Public Safety _ ness Rego atioa t WlE IMPROVEMENT CONTRACTOR �f Board of Building Regulations and Standards - egistmdf3n. 144064 Tie- License: CSFA-046604 Phtion: 9/7/?_016 -DBA Construction Supervisor 1 & 2 Family DAVID GRAHAM C(J§TOIU,bUlWlNG DAVID M GRAHAM f 66 FED€RAL STREET o DAVID GRAHAM NEWBURYPORT;MA 01950 66 FEDER;L ST,. NEWBURYPORT,fftA 01950 U:aurs2aretary P—j^^^ vim— Expiration: 09/02/2017 it Location ' �r No. ,/cera '" c�d l�' Date S3 IfAO i • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �� -- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# v Building Inspector v