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Home My WebLink AboutBuilding Permit #581-2016 - 124 PENNI LANE 11/10/2015 9.A/U/I/F� � ,/Z" fS- OORT#f -_ BUILDING PERMIT ' o�o� TOWN OF NORTH ANDOVER ti 'J APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received e � n e Argo 04q ca«c«:.rt y1� Date Issued: u ACHUs MPORTANT:Ap2licant must complete all items on this page LOCATION all PPePW i Loy, Print PROPERTY OWNER DO r+5 / a�4(I Ngsrd s4r 'r-n Print MAP NO: Al .PARCEL 6; ZONING DISTRICT: Historic.District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building $One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial V Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well 0..Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer lo w - Ae-01) kra lei v ('� 12eoCu�r $1diiv-e Identification Please Type or Print Clearly) OWNER: Name: Por;-5 0'�c1 NeircS,�-Vrh Phone: Address: fail eliji t,,lA0vwe— CONTRACTOR Name: 5A,6f Yry ,W Phone: ,3Z.0 S'�/ 3 9,q g Address: ; 14, Supervisor's Construction License: Exp. Date: Home Improvement License: ` Exp. Date. ARCHITECT/ENGINEER Phone: Address: 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: $ 60i d o o FEE: $ C1 LOD Check No.: Receipt No.: SA ie 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Owner Signature of contractor - BUILDING PERMIT of No Dr b quo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � o Permit No#: Date Received 'ls�A�RArco IPa �y gSSACHUs�( Date Issued: 1 IMPORTANT: Applicant must complete all items on this page LOCATION, ,Print. PROPERTY OWNER 'Print 10.6 Year"8trucure yes. no: MAP PARCEL: ZONING DISTRICT ___._ - Historic District yes no Machine Shop Vill'ag.e yes 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 0 Septic. ❑ Well. ❑floodplaim 0 Wetlands ❑ Watersheds District 0 Wager/Sewer _v DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: s Contractor Name:- _ ___ __ _._ = Phone: Email: AddPress:. Supervisor"s Construction License _z Exp. Date: Home Improvement License - - _-_ ---_-Exp. Date-:- ARCH ITECT/ENG I NEER ate:ARCHITECT/ENGINEER 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund g;nature of Agent/O��rner --_ Signature of contractor _l e 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 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 o 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 o 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) o 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 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. ❑ Pennanent 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 Siqnature 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: ,SPIRE DEPARTMENT =`Te pal®umpst'errorisite yes - 3noOs Located good Street r _� ILocated�at 1F24�Main1 Street - �" - � ' Fire EDepr7tmentFsiauxe/date i f 4 i 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.$10o-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 Location i No. Date97 • TOWN OF NORTH ANDOVER � zrn; Q •e.. Certificate of Occupancy $ j $96() Building/Frame Permit Fee w }; I. R Foundation Permit Fee $ Other Permit Fee . $ - '' , ern TOTAL $ ' k Check# j 'A/ 29656 Building Inspector F NORTH Town of E f. ndover . O - 0 "IN6 1591- 201� .1 Z h ver, Mass ( O � COG"K.t WICK U BOARD OF HEALTH Food/Kitchen PE . IT Septic System THIS CERTIFIES THAT ... { ... .......... e4rBUILDING INSPECTOR ....... ............................. .....P ............................ has permission to erect .. ..................... buildings on P.4.........A , a��. Foundation f t ` Rough to be occupied as . ..! ..W..v-4-a- -st ....■... . ... � ............. Chimney provided that the person ccepting this permit shall in every respct conform to the terms of thelication 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 CONSTRUCTIO ARTS Rough P Service ............. ..... ... rs... 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. HILL RD,AsasoxNHAMI MA 01430 pLmSTATECONSTRUCTTON.COM 59 JEWELL 508-581-3798•FAX 508-519-5888•nvFo PROPOSAL Project: Nordstrom Windows&Siding 2015 Bid Date: 10.9.15 Attu; Doris&Robert Nordstrom Phone#: 978.689.4503 Work#: Company: Cell#: Address: 124 Penni Ln. City,State,Zip North Andover,Ma Fax#: 13eferred By: Shriner's Home Show Email: renordy@aol.com PAYMENT TERMS &OPTIONS ✓ Base proposal total $ 40 600.00 ✓ Alternate 1 total$ 44L850-00 ✓ Marketing Cost Savings Plan 5%Discounts 5A50-00 Total Job Amount Authorized: $ 80 000.00 ❑Ck X CC A non-refunds deposit due upon authorization in the amount$ 2626• d— o Ck X CC An additional payment due at job start °f' 13500. ❑Ck X CC An additional payment due at completion of windows of: $ 3.5_00.00 plus any customer requested additions. c3 Ck X CC The balance due upon siding completion of$ 1 i authorize Solid State Construction to charge the above referenced amount(s)to the above referenced account(s)according to the agreed pon payment sch d 7 Signature Date Disclosure: State Saw requires us to inform you of contract liens.Any contractor,supplier,or subcontractor may lien your real property if you or the general contractor fails to pay for goods or services delivered or installed at the work location.some contractors and suppliers automatically send letters of notification similar to this notice. At your request,we will provide original lien release documents from anyone who provides said material or service. Please call if you have any question regarding liens. Acceptance: The signature on this proposal reflects acceptance of the proposal as per the attached scope of work,authorizes commencement of the work,an hereby guarantees payment as outlined above. Any amounts not paid within thirty days of invoice are subject to service charges of 1'/z%per month (i so/-APR). Ali costs of collection,including reasonable attorney fees are to be paid by the customer. / 1 l�s� x Co ractor igna re Date Customer Signature Date $1,000,000 Liability Insurance 0 Warranteed Work•MA CS License#96770•MA HICR#179155 r 00 59 JEWELL HILL RD.ASI3BURN13AM,MA 01430 508-581-3798 o FAX 508-519-5888•INFO@SOLIDSTATECONSTRUCTION.COM JOB: NORnSTROM WINDows& SIDING 2015 SCOPE OF WORK: JOB SCHEDULED FOR WEEK OF 11/9/15.APPROX 3 WORKING WEEKS. BASE PROPOSAL: The base proposal price includes the following: Supply building permits,labor,materials to: 1. Demolition-Remove 28 Primary vinyl double hung windows and 1 primary casement window.Full frame removal-all interior trim to be removed,all siding around windows to be removed. Entire window to be removed leaving rough frame only.Inspect rough frame and advise of condition.Remove and dispose of all primary windows. 2. Preparation-Clean RO.Install Vycor or equivalent ice and water shield tape to bottom of RO. 3. Windows-Install 29 Simonton Brickmold 600 series double hung,white interior and exterior,Double pane, Lowe coated glass with argon gas fill,approx.U factor Z9.Jamb depth is 6 9/16" 4. Trim-Install factory made 5/4x 4 flat casing to exterior.Install 2.5"colonial casing to interior. 5. Siding-See alternate 1. 6. Full job site clean up and removal of all job related debris. 7. Interior finish to be completed at same pace with exterior. 5 year warranty on all craftsmanship.30 year non-prorated manufacturer's warranty on all JH materials. ALTERNATES: The options are available at additional cost: 1. Demolition:Remove all siding,door and garage door trim.Inspect underlying sheathing and advise. 2. Siding Underlayment:Install ice and water shield to sidewalls of shed dormer.Install James Hardie house wrap to all other siding areas. 3. Siding:Install James Hardie Cedarmill Lap siding(clapboard)to house,approximate Exposure to be 4"and color to be Light Mist.Install all appropriate flashing detail.All nails to be stainless steel ring shank siding nails. 4. 'Trim Detail- a. Corners-Install JH trim or cellular PVC 5/4x5 corners b. Windows-Windows will be new construction with built in trim as above. c. Fascia,soffit and Rake boards-Leave existing wrap intact.Customer understands that if any wraps are found to be substandard or if they need to be disturbed to complete siding work they will be replaced at a cost of$8 per LF with custom formed aluminum trim stock. d. Cheek wall-Install approx.2"cellular PVC trim to roof line. e. Skirt board-Install cellular PVC skirt as needed. E Install all new JH light blocks and vent covers. g. Garage doors and patio doors-Case with Cellular PVC trim. h. All cellular PVC to be fastened with cortex screw and plug system.All Hardie trim to be installed with finish nails and touched up. MARKETING COST SAVINGS PLAN: To help defray SSC's marketing and sales costs,customer agrees to the following: 1. Contracting job at time of proposal 2. Writing and posting a member review of Solid State Construction on Angie's List.If customer is not already a member,this will require becoming a member. In consideration of participation in this program,customer will receive discount listed. EXCLUSIONS: The following items are specifically excluded from the job: 1. Any rotted or sub-standard decking to be replaced at an additional cost of$45 per plywood sheet or$3.50 per linear foot.Any structural rot will be priced when seen. 2. .lob includes above scope only. Any additions to the above scope will be priced when discussed. 3. Interior painting/prep. $1,000,000 Liability Insurance o Warranteed Work o NIA CS License#96770 s MA HICR#179155 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 "t www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Auplicant Information Please Print Leeibly Name(Business/Organization/Individual): Solid State Construction, LLC Address: 59 Jewell Hill Rd. City/State/Zip: Ashburnham, Ma 01430 Phone#: 508-581-3798 Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with 3 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.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4. 1 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 ro rietors with no employees. P P 12. Plumbing repairs or additions p 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub contractors have employees and have workers'comp.insurance. t 6. We are a corporation and its officers have exercised their right of'exemption per MGL c. 14. Other gh ❑ � P 152,§1(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 I am an employer that is providing workers'compensation insurance for nip employees. Below is the policy and job site information. Insurance Company Name: Traveler's Policy#or Self-ins.Lic.#: UB-2E658587-15 Expiration Date: 1/15/16 Job Site Address: d�y 1� �N� Ltl- City/State/Zip: AJWA WlA 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 pai d penalties of pe>jury that the information provided above is trite and correct. Si ature: Date: 11/9/15 Phone#: 67 508-581-3798 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#: 11/10/2015 12:44PH FAX 5087556412 THOMAS WOODS INSURANCE 20002/0002 AC CERTIFICATE OF LI ABILITY INSURANCE OATE(MMIDDA^IYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPI�N THE CERTIFICATE HOLDER.2015 S 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 ORDEDR(S), HE POLICIES REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holdor Is an ADDITIONAL INSURED,the policy(los)must bo ondOrsod. If:SUBROGATION IS WAIVED,subJoct to the terms and conn I lops of the policy,certain Policies may require an Ondorsemont, A statomont on this corttficato does not confor rights to the certificate holdor in Ilou of such endorsement s. PROOUCER THOMAS J. WOODS INSURANCE AGENCY, INC. NAMa: Lori Bigelow P"c N. tm; (508 755.5944-MAIL /A�� 20 PARK AVENUE DDRrsa: IbIelow woodslnsurance.com — WORCESTER IN9URCR(g)APPORDIN(:COVLrRApB NAICP _ INSURED MA 01613 INauReRA: TRAVELERS PROPERTY CAS CO OF AM 25674 SOLID STATE CONSTRUCTION LLC INBURERC: -- INSURER c 58 JEWELL HILL RD INSURERD: ASHBURNHAM INSURER E: MA 01430 INsuReR•; COVERAGES CERTIFICATE NUMBER: 11365 THIS IS 70CERTIFY THAT VISION NUMBER: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED EN4MC0 A OVL I-QR 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 SUBJCCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR 9U T TYPpO/INSURANCE POLICYNIJMBER PMYP ]IRALTA COMMERCIAL GENERAL LIABILITY LIMITS CLAIMS-MADE ❑OCCUR H OCCURRENCEdCE6RENT6��ies EXP(AN/A GEN1AGGREGATE LIMITAP(PLIES PCR: ANAL RADV INJURYPOLICY❑JECT 0 LOG GGREGATEOTHPR; 7UCT�•COMP/OP AOC $ AUTOMOBILELIABILITY $ ANVAUTO SCIgggl) LIM! S All OWNED SCHEDULED BODILY INJURY(Por Darton) y AUTOS AUTOS NIA N!A BODY-Y INJURY(Por atGldanr) S HIREDAUIOS AUTOS fiC1+ T—DA�r UMBRO LALIAO OCCUR S CXCESS LIgD EACH OCCURRENCE E CLAIMS-MADE- NIA _ DPO R TENTION AGGREGATE S. WORKQRa COMPeNSATION g AND BMPLOYORG*UADILITY YIN N �/ ANYPROPRIETOWPARYNErVEXECUTIVG X T A OFFICERIMEMBEREXCLUDED9 NIA WA NIA 7PJUB2E65858715 01/15/2015 01!15/20113 F,L.EACNACCIDENT S 10D,O0 (Mandalory In NH) ll yea,deeadbo under E.L.DISUSE-EA EMPLOYEE 10Q,Q0Q DF>i RIPTION F OPERATIONS below _ C.L.DI:SEASF.-POLICY LIMIT R 500,000 N/A DESCRIPTION OF OPERATIONS r LOCATIONS f VpMCLES (ACORD l".Addllionol Rameeka$oWulo,may be altnoh*d If mor*apeaa If ratlulrod) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization 13 given to pay claims for benefits to ompioyees in states other than Massachusetts If the insured hires,or has hired those employees Outside of Massachusetts, This certificate of Insurance shows the policy In force on the date that this certificate was Issued(unless the expiration d$Ite on the above policy issue date of this certificate of Insurance). The status of this coverage Can be monitored daily b accessing P Y Precede$the Search tool at www.mas Y Y the Proof of www.mass-gov/lwd/workers-�componsation/investigatlonq/, A Coverage-Covera e V ri p 9atioMnvoatlgatlons/, g o flcatlon CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICYPROVI$IONS. 1500 Osgood St AUTHORIZED REPRESENTATIVE N Andover MA 01845 1'3_11 (,, Danlol M.Cr y,CPCU,Vice President–Residual Market–WCRISMA ACORD 25(2014101) ORD The ACORD name and logo oro registered marks of ACORD CORPORATION. All rights reserved. 1/10/2015 12:44PM FAX 5087556412 THOMAS WOODS INSURANCE 2 0001/0002 SOLID-1 OP ID;L6 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 711/1012015 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(les) must be ondorsod. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain pollclos may require an endorsement. A statement on this certificate does not confor rights to tho certificate holder In lieu of such endorsement(s). PROOUC,R CONTACT Thomas J Woods Insurance Agcy NAME, Jack Woods,CPCU P.O.Box 2940 _ H :E F911M.,tl911M.,508-755.5944 FAX AIC.No):508.791-9841 Worcostor,MA 01613 -MAIL Jack Woods,CPCU ��•-- __ _ IN9URER(5)AFFORDINO COVERAGE NAIC tl _ _INSURER A!Atlantic Casualty In■co INSURED Solid State Construction LLC INSURER e: 59 Jewell HILI Rd -- _ Ashburnham,MA 01430 INSURERC: _ rNSVRER D: INSURER!: — wSUaER 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. INSR .OL'9U8 - ' LTR TYPe OF INSURANCE POLICY NUMBER MM/l 1Y1'YY NIMH IC IYYW LIMITS A X COMMERCIALGQNQRALLIA8ILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE U OCCUR L185000440 07107/2015 07/0712016 _M p 7ED S X Deductible $1000 Pj 31`SE ( 100,000- _ MCD CXP(Any ono person) S 5,000 - .... PERSONAL BADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMN APPuEs PCR; GENERAL AGGREGATES 2,000,000 X POLICY❑jECT u LOC - PRODUCTS-COMP/OP AGO S 2,000,_0.00 OTHER' $ AUTOMOBILE LIABILITY 0 M IN- Lt LIMIT f (EP aocld�nl) _ ANY AUTO BODILY INJURY(Por porton) S ALL OWNEDOS DULCD AUTOS BODILY INJURY(Per accident) $ . AUTO HIREOAUTOS NON-OWNED PROP AMA S' AUTOS Pr I UMBRELLA LIAR OCCUR EACH OCCUHNeNCe _ S EXCESS LIAB CLAIMS-MADE A(7CREGATC S DED I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N _MUTE R _ ANY PROPRICTOR/PARTNER/EXECUTIVE OFFICMMEMSEC.L.EACH ACCIDENT S R EXCLUDED7 ❑ NIA _ s.. (Mandatory In NH) E,L,DISEASE•EA CMPLOYE S _ Ity3 describe under DESCRIPTION OF OPFRAYIONS below E.:.DISEASE-POLICY LIMIT y DESCRIPTION OF OPIRATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may bo attached 11 mora space In r9qulrod) CERTIFICATE HOLDER CANCELLATION TOWNNAO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT. 978-688-9542 AUTHORIZED REPRE58NTAYIV, 1600 OSGOOD ST Jack Woods, CPCU NO.ANDOVER,MA 01845 ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts-Department of Public Safety Boars!of Building Regulations and Standards Construction Supervisor License: CS-096770 1 JEFFREY R BROSi'KS - '',, 59 JEWELL=MA014 °Ashburnham }I v .•sfw+.�/..^� Expiratipn Commissioner 02/07/2016 671, L('��r�.)rrc�z{aea� o �/li�.�zdJacllr�aei Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration. 179155 Type: Office of Consumer Affairs and Business Regulation _ xpiration: 6/271201.6. LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 SOLID STATE C0NSTRUCTION..LLC BROOK JEFFREY 59 JEWELL HILL RD C< ASHBURNHAM,MA 01430' ter— 60 _ Undersecretary t valid without nature