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HomeMy WebLinkAboutBuilding Permit #242-13 - 125 MARBLERIDGE ROAD 9/25/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 2' 2 '� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Priat PROPERTY OWNER /����xM A&/-/— Unit# Print MAP NO: ARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building WOne family V❑ ddition 0 Two or more family El Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition_ ❑ Other � ptic~ I ❑Floodplamt OWetlands, [fit® WatershedDstriet } ,0 Waferewer Jt - DESCRIPTION OF WORK TE PERFORMED: l i (Identification Vlease Type or Print Clearly) OWNER: Name: Phone: 7 Address:,1 � /fl��f� �l�/✓� � �—��l�� / �U�� CONTRACTOR Name: �44 �i� /3�Phone: 2�V Z,777 Address: , tJ fTZ-fl- 21 Supervisor's Construction License: � Exp. Date: Home Improvement License: —/!!x/ /0a Exp. Date: ARCHITECT/ENGINEER Phone: 7 Address: Reg. No. , FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: FEE: $ Check No.:xz Receipt No.: ;2 S'/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of'A ent/Owner - , Signature of;contra i 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products (VOTE: 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building pp Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li 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: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 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 'i Water& Sewer Connection/Signature& Date Driveway Permit "'DPW Town Engineer: Signature: Located 384 Osgood 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 i f I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location 14�r /YlG" No. 'R L��— / 3 Date e ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee J ` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 76,2 6,2 ` 4/// � t 25751 BuildAff Inspector t F . NORTH - . w: 1 t E ic . . ver 0 . � ro h ver, Mass, C OC NIC Ne WICK �a ADR�tED �'4�,�'�y •`` S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... r �1 !: ......- AA./r' BUILDING INSPECTOR ........................................................................... �hk��� Foundation has permission to erect .......................... buildings on ./ .................. �J......... .......................... R gh ou to be occupied as .... .................................................. 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 Godes 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 CONSTRUCTION ST RTS Rough .......... ........ :..... .. .. . Service ...................... .� B U DING INSPECTOl2 Final 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. SEE REVERSE SIDE Yu 690 G.L.C.A.C., INC. ©OCoG�a`f� 350 ESSEX STREET LAWRENCE, MA-01840l-- WEATHEPUATION ASSISTANCE PROGRAM 3 WORK PERMIT ! (Ill t 1 r Am A�'L l T certify that 1 am the owned authorized agent property errt for the at: 1 ZS M'A R 8 L6Z/D G&,F , (Address) I further certify that 1 have given my permission to allow work on the property listed above in accordance with the following provisions: WEATHERiZATION HEATING SYSTEM WORK 3. 4. -and-such-other particulars as Wray-be-attached-to this-agreeme .-.- .-.._.._. ---'- -SIGNED:� -.. - -- - ---- - DATE: � . OWNERIAUTHORIZED AGENT Job Number 4374 811212012 cil�m William Arlit aaarees 125.MarbleridgeRoad city I town No.Andovet.978-688-64831978-828-6981 contractor Heat•Quest 1.WEAT14ERBTRIPPINti/CAUEtCING QUANTITY TOTAL AUDITOR NOTES Door Kits Q-Lon or Equiv. 1 45.50 2 . 31.50 Door Sweeps(Regular) 0 0.00 Door Sweeps(Autornalic) Reglaw Windows lln:inch 0 0.00 0 0.00 Window.Weathstr Schlegel per side Tenmat Recessed Can Cover; 0 . 0.00 2.75-:. 208.25. AtticlBssementbypass sealing manmr Attic sealing wdh,2-part foam manmr 0 0.00 .283.26 SUBTOTALS .AUDITOR NOTES 2A.INFiLTRATION i INSULATION . . . • Domestic pips Hot Water Tank 1 at 6' 0 0.00 50. .79.00 Sill Insulation R-19 CF Sill Two Part.Foam W/Fiberglass Bari 0 0.00. Drape Perimeter R-5 Arich.Sq.ft. 0 0.00 Perimeter 2°T-max or equivalent foam board sq ft. 0 . 0.00 Drape'DOOR R-5 or T-max or equivalent on.door; 0 0.00 Tape.Joints'(Alur6a Grip only)per hr. 0 0.00 Duct Insulation.&Tepe sq.;ft:R-5 0 0.00 Rigid Foam Board Anch. 1"per board 0 0.00 Hydronic pipe insulation to 1"R-5. 62 211.42 HydIonic pipe ins.1:25"-1.5"k6109 401.12 Steampipe'ins.-tol.25"Iron pipR-5 0 . 0.00 . .. . .e Steampipa Ina._1.0 2"iron pipe R-5 .0. 0.00 0 0.00 Steafnplpe ins.;3"iron pipe R=5 0 0.00 Air Conditioner.Meeting Reil Air Conditioner Cover 0. 0.00 Air Conditioner Cover Special Order 0 0.00 SU8TOTALS . 881:64 AUDITOR Nom_ 2B.INSULATION Open Unrestricted R 49 0 0.00 . Open Unrestricted R 38. 288 423.36 Attic Area Pull Back Fiberglass 3' Open Unrestricted.R 30 0 0.00 Open Unrestricted.R 20 768 990.72 Open Unrestricted R 10- 228 0.00 Restrict FL R 30 228 337.44 FrantRoof Area Sloped R 20 . . 0 0.00 Reswct FUSloped R 10 0 0.00 R-19 FGB open rafters/wallsAneewalis 0 . 0.00 R-11 FGB:open rafteisMratMMIDewalis 0 0.00 Attic,Stairs(stainaell.&common#all) 0 0.00 Cover Pull Down Stairs Therm adome p 0.00 0 0.00 Site built pull down stairs 2"foam.box AUDITOR NOTES Attic/Kneewal Floor Transition.Dense pack cellulose 0 0.0.o W.S.Hatch Q-Lon or equal. . . 0 0.00 W.S.8 bat Hatch R-30!Q-Lon or= 0 0.00 Kneewall R-12 peU.behind per;Memb. 0 0.00 Open Rafter R-20 Cell./w poly 0 0.00. 0 .0.00 Open Rafter.R-30 Cell.1w poly .. Basement`Overhead R719 fiberglass 0 Basement Overhead R-W fiberglass .0 0.00 0 0.00 Crawpace Overhead<4'high:.R19 Crawtpaoe Overhead<4'high 111300 0.00 Garage Ceiling.cevity filled W cellulose 1072 2251.20 Wood,Shake,taapboard,Shing les Vinyl. 0 0.00 :. Asbestos(single nail)/Asphalt 0 0.00 0 0.00 • Asbestos(daub.Nail)/Aluminum Brwstucco 0 0.00: .' Vinp.over Asbestos o 0.00. Nlulti4ayere4 3.or more layers 0 0.00 Dn11 rough plaster or finish wood plug p 0.00; brill"finish plaster 0 0.00 Test Drill Walis.(all4) 0 0.00 4002.72 SUBTOTALS. 2:INSULATION TOTAL 2A-+2B AUDITOR.NOTES 3.STORM WLNDOWS I DEADUTES Plexiglass up to 88 W. 0. 0.00 Additional per Ut over 88" 0 0.00.. Other(Negotiated Price) 0 0.00 SUBTOTALS. 0.00 AUDITOR NOTES 6.,OTHER MATERIAL Ridge vent In ft; 0 0.00 Vents Gable rectangular 8. :. 552.00 - 6z16 Var(pitch Vent 0 0.00 0 0.00 VentR60f 135(1..sq ft NFV)Large Vent Roof 865.(.4 sq ft NFV)Small 4 320A0 Vent Soffit Rectangular 0 0.00 0 0.00 Turbine Vents All 0 0.00 Stack Vent . Propa Vent 8 24.00 0 0.00 Permable House Wrap 80 60:00 Vapor barrier Energy Star:R-4 Rigid Vinyl Repl 94-101 U.I. 0 .0.00 1166.00 SUBTOTALS 6.17,E.C.AAATERIAULABOR. N33.81 Pagel AUDITOR NOTES. 8a.: .HEALTH&SAFETY Vent Bath 1 Kitctien Fan 1 89.00 Dryer vent wl exhaust duct Heartland 1 89.00. Dryer Transition Duct_ only 0 0.00 Blower Door Test PrePost t 45,00 SUBTOTALS 223.00 AUDITOR.NOTES 8b.REPAIR MATERIALILABOR Basement'outside door only 0 0.00 Basement outside•door w!jambs 0 0.00 DoorRepl pre tiun9 "Steel"`w/Lite 0 0.00 Door ReP(Utedorsolld•core 28-32" 0 0.00 Door Repl pre.hung 3238"wood"w I Lite . 0 0.00 Window Replacement W SIR less than t 0 0.00 Basement Window Repl.Awning!Hopper 0 0.00 Basement Window,Repl.With:a frame. 0 0.00 Lodmet(door)Sohlage'Of equal 0 0.00. . 0 0.00 Repair.!Refit Door ... Replace Side Stop . 0. 0.00 Replace-Casing Or 0.00 Glass Replacement to 64 u.i. 0 0.00 Glass Replaceent per u.i.over 84 0 0.00 m Sash Sideiock/1'op Replacement 0 0.00 Threshold(Wood)_ 0 0.00 Threshold(Aluminum) • 0 0.00 Slides Bolts . 0 0.00 Plug Plate Cover 0 . 0.00 but/finish attic-kneewall.access. 0 0.00. Cut:!close attiakneewall access 0 0.00 Attic Area to Pull Bade, Labor Rate Hours 1.5 90.00 . 0. 0.00 Permits./Fan.(Wap only) SUBTOTALS. '_. . . 80.00 TOTAL REPAIR+MEALTH&SAFETY 313.00 . GRAND TOTAL WORK ORDER fie (A) 4374 8246.61 WIIllam Alit 125 Marbleridge Road NaAndowr 9784884483 f 978"8284881 Any alterations or deviations from the above specifications Involving extra costs must be cleared in writing before installation. The Work Order must be complete within 15 working days from acceptance date below. CONTRACTOWCOMPAMY: Heat Quest ACCEPTANCE:Company/Coptractor Date- AUTHORIZED-SIGNATURE: 8i@AUTHORIZED SIGNATURE: AGENCY APPROVALS: Date - CTI Authorized Signature: Date GLCAC Autho lZW Signature: DPI$-(,A! tia h�P9-t�F'Q1-u i.tttU, %��r /`tUtuilr,ixf/avI/�l7 .�' (l�r.;ur�tf.�al! Office of Consumer Affairs&Bu<iness Reputation "' HOME IMPROVEMENT CONTRACTOR n4' Registration: 141124 Type: �w' Expiration: 1/12/2014 Supplement Card A+M GENERAL CONTRACTING INC. MICHAEL FITZGERALD _ 5 SOUTH RIDGE CIRCLE — LYNN,MA 01904 Undersecretary Massachusetts -Depart-hent of Pt:tst;c Safety Board of Budding Requiat.ons and Standards Con%tructii,n Super%kor Spcoalt% ecense CSSL-099933 MICHAEL P FITZGERALD 10 Overlook Trail*1018' Peabody XA 01960 j. ornrrus +craer 06/19/2014 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): AA _ Address: Ci /State/Zip: Phone#: ZI Are ou an employer?Check the appropriate box: Type of project,,(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp.insurance comp,insurance.1 required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs c. 152 1(4),and we have no /w/�� /��r� 1� insurance required.] ' § /!/ h ��/ employees. [No workers' 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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 sub-contractors 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: �. Policy#or Self-ins.Lie.#: �2 �(i .3 Expiration Date: ,� 4,P Job Site Address: � �� Rl a � /�;q City/State"04 4- 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 MGL c. 152 can lead to the irnposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. .l do herebMtrfj derthepains anal enalties of e zat the information provided above 's trice a d correct. Sienature: Date: Z 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#: ffnfoir floe and hotirueflons Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or :own)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. the Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, Tease do not hesitate to give us a call. 'he Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston,MA 02111 Tel. # 61.7-727-4900 ext 406 or 1-877-MASSAFE •ised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia A&MGE-1 OP ID: SM ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DD/YYYY)03M22/12 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). CONTACT PRODUCER 781-914-1000 NAME: TGA Cross Insurance,Inc. PHONE FAX 401 Edgewater Place,Suite 220 AIc No Ext): (AIC'No): Wakefield,MA 01880 E-MAIL ADDRESS: John Scanlon INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Co INSURED A&M General Contracting, Inc. INSURER B:Guard Insurance Group Norman Dube INSURER C 119R Foster St. Bldg 14 Peabody,MA 01960 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. YINSR POU EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAUF TU HEN 11:15- A X COMMERCIAL GENERAL LIABILITY CBP8833284 03/20/12 03120/13 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE FKOCCUR MED EXP(Any one person) $ _ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ A ANY AUTO BA8762301 03120/12 03120/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS I X I AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS Per accident X X UMBRELLA UAB I X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE CU8762501 03/20/12 03/20113 AGGREGATE $ 1,000,000 DED X RETENTION$ 10000 $ WORKERS COMPENSATIONX WC STALIMTU- OTH- AND EMPLOYERS'LIABILITY T B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN MWC345622 03/20/12 03/20/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? FNI N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWNAN 1 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. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE �� ©1988-2010 ACORD CORPORATION. All rights reserved. ...---wrt... A/%Aor%name—A Inns ern ro iat—A mar4a of A(npn