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HomeMy WebLinkAboutBuilding Permit #1308-2016 - 129 MOODY STREET 6/15/2016 NORTN '9 1 BUILDING PERMIT O ,t�eo ,6 �•o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7° Permit No#: Date Received v 4 ~ fey � TED gSSgcHus�`��y Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER �G Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi5p..qtiaI Non- Residential ❑ New Building &05ne family ❑Addition ❑ Two or more family ❑ Industrial ❑A ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: dentifi ation- Ple a Typ or Print Clearly OWNER: Name: � Phdne 7, / Address: Contractor Na l' ✓ Phone&— �---ocl Email: Address: Supervisor's Construction Licens �o l� Exp. Date: Home Improvement License: 7 �✓ Exp. Date: "' ARCH ITECT/ENGINEER ,e���/000�� Phone: Address: Reg. No. FEE SCHEDULE.13ULDING PERMIT.$12.00 PER$1000 aQ OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: "/ Receipt No.: 36�� NOTE: Persons contracting with unregistered contractors do not have access tot uaranty d - --- i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/1V4assageBody 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 ..,lanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMENT Temp+.Dumpstersontsiter ►yes ._ no _ _ ► Located;at 4,244 MainzStreet F, rerDepartrYient 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) ❑ 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 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work :rc Engineering Affidavits for Engineered products OTE: 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 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) -6 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) 4r Building Permit Application :rF 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 must be submitted with the building application Doe:Building Permit Revised 2014 C- `� Location 1 t !C ,�`` r No. V �� 6– �� V Date , t • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ a-o — Foundation rFoundation Permit Fee $�• Other Permit Fee $ TOTAL $ r' ++\\ t Check# ' �� Building Inspector NH ORT wn of �? . : _ : .,To LAndover O 0 No. I h , ver, Mass, k 1.eb0 COCNICH�WICM �.95°R�reo �Pa��S U BOARD OF HEALTH Food/Kitchen T LD Septic System THIS CERTIFIES THAT L......... BUILDING INSPECTOR ....................PERM !7 ..4....... ...... ......... ........................... has permission to erect .......................... buildings on ......�.�. .. ....... .dQ.l ... „�>, ,,,,,,,,,,,,,,,,, Foundation Rough to be occupied as �. ............ .. .......�....� � ................................................................... Chimney provided that the person accepting thepermit 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough Service . . ..... ......... ......... ............. Final B DING I PECTOR 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. Proposal • eaes HIC#174377 .l VPI Damphouse® 20102015 Roofig n LLP A trusted name since 1938 Roofing - Siding -Windows 87 Belmont Street - North Andover, MA 01845 P: 978-683-4588 - F: 978-685-7446 NAME OF OWNER -- ADRESS OF JOB /G%y A TEL. '� DATE: We will remove all roof shingles off total roof area layer. Replace an boards or sheathing at 9 � Y P Y 9 additional cost.A new 8" white aluminum drip edge applied on all edges. Approx. 6ft of ice and water membrane applied on eaves, 3ft in valleys, strips around skylights, along chimney flashing and sidewall junctions. Existing step flashings to remain. A new base sheet applied. Architectural roof shingle installed with a limited lifetime warranty. Install new ve tpipe b0000t, flashings. aterproof existing chimney flashing and remove debris. Shingle Color: AQ c—�; Rid a Vent Upgrade Wood Sheathin.q Repair$3.50 per ft. 4�z- Amw We Propose herby to furnish material and labor-complete in accordance with above specifications,for the sum of: Payment to be made as follows JOY f ,C t� Authorized Signature NOTE:This proposal may be withdrawn by us if not accept with in 24ays I Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are herby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. n Signature C t Date of Acceptance: Signature I HOME IMPROVEMENT CONTRACT TERMS AND CONDITIONS(M.G.L.142A) 1.WORK:Provided the Homeowner performs under this agreement,the Contractor shall perform the work on the Property as specified Proposal,attached incorporated herein.The work does not include extraordinary conditions of which the Contractor could not reasonably be aware.If such conditions are encountered,this shall be an additional cost to the Homeowner.Materials selected by Homeowner may have to be ordered or custom made,which items are specified in the Proposal.The Contractor is not obligated to agree to any modifications,extras or change orders unless such items are agreed to in writing by the Contractor.All extras and changes shall be at an additional cost to the Homeowner.Contractor shall perform the work in a good and workmanlike manner using materials consistent with this contract.Lawn or Driveway may be damaged by dumpster or equipment.Due to material shortages Contractor may substitute materials of equivalent grade. 2. PERMITS:If a building permit is required for the work,the Contractor shall obtain same as Homeowner's agent.Contractor is not responsible for any other permits that may be required for the Work,and Homeowner is responsible to determine whether any zoning,planning or wetland related permits or approvals are necessary.Homeowners who secure their own permits or deal with unregistered contractors will not have access to the Guaranty Fund. 3. COMMENCEMENT AND COMPLETION:Homeowner acknowledges the commencement date of the work is fluid,and is subject to numerous factors such as scheduling other contractors,delivery of materials and weather.Contractor and Homeowner shall determine the commencement date of the Work when a more definite determination can be made and shall execute a written acknowledgment of same.The Work shall be substantially completed within 7 days of commencement,except for longer periods as may apply to particular projects as Contractor shall notify Homeowner in the Proposal,and subject to delays for circumstances beyond Contractor's control.Notwithstanding,the commencement date and substantial completion date may be extended,and the Contractor will not be liable for delays caused by,labor or material shortages,delays in delivery of items selected by the Homeowner,governmental action, and unforeseen events beyond the Contractor's control,including but not limited to weather,strikes,war,the acts of third persons or the acts of the Homeowner.The Homeowner recognizes that the commencement date may be delayed due to scheduling or the completion of Contractor's other jobs. 4. PAYMENTS:Contractor agrees to perform the Work and to furnish the materials and labor specified in the Proposal for the amount as stated in the Proposal.Thirty percent(30%)of the total is to be paid as a deposit with the signing of this contract.Upon cancellation prior to commencement of the Work,any remaining deposit will be returned less the costs for materials ordered for which Contractor was unable to cancel.Final payment shall be due upon completion of the Work and Homeowner agrees it may not hold any retainage.Late fees may be applied for late payments.Homeowner shall pay Contractor's reasonable costs of collection,including attorney's fees and costs.Time is of the essence hereof. 5. WARRANTY:For a period of 2 years after substantial completion of the Work the roof will be free of leaks caused by defects in workmanship, but not those caused by ice backing-up or extraordinary weather events,including blizzards,tornadoes,hurricanes or storms of greater than a twenty-five year duration or intensity.Contractor gives no warranties with reference to any materials or equipment installed in the Premises,passes any such warranties directly to Homeowner,and Homeowner agrees to look only to the manufacturer with reference thereto.This limited warranty extends to the Homeowner only and is not transferable to succeeding Homeowners.This Limited Warranty specifically excludes(i)all consequential and incidental damages;(ii) damage due to ordinary wear and tear,abusive use,misuse,or lack of proper maintenance;(iii)defects which are the result of characteristics common to materials used;(iv)defects in items installed or supplied by anyone other than Contractor;(v)work done by anyone other than by Contractor;and(vi)loss or injury due to the elements.There are no other expressed or implied warranties or representations made or given. 6. ENTIRE AGREEMENT:This contract and all documents referenced herein constitute the complete and final agreement between the parties.In the event that any of the provisions of this contract shall be held to be invalid,the remainder of the provisions of this contract shall remain in full force and effect.Two identical copies of this contract have been completed and signed.Homeowner acknowledges receipt of a completed contract signed by the Contractor. 7. HOME IMPROVEMENT REGISTRATION:In accordance with M.G.L.c. 142 A,§9,Contractor is registered with the Bureau of Building Regulations and Standards Registration No: 174377.Homeowner may verify by contacting the Director at(617)727-3200,ext.25205.A Homeowner's rights under the Home Improvement Law(M.G.L.c. 142A)and other consumer protection laws may not be waived in any way.Homeowner acknowledges receipt of a copy of 780 CMR R6 and Massachusetts General Laws chapter 142A,and which are available online at www.mass.gov.Questions may be directed to the Consumer Information Hotline,(617)727-7780. 8. ARBITRATION:Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has a dispute concerning this contract, the Contractor may submit such dispute to a private arbitration service which has been approved b the Secreta of the Executive Office of Consumer Affairs Y P P PP Y Secretary and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L.c. 142A.No lien or security interest is imposed on the Property as a consequence of this contract,but Contractor has the right to record this contract or a notice of this contract,or seek a lien if the Homeowner breaches this Contract. 9. HOMEOWNER COVENANTS:The Homeowner agrees,represents and warrants that(a)the Homeowner grants permission to the Contractor to enter the Property to perform the work as covered by this contract;(b)the Homeowner has funds available to make full payment under this contract to the Contractor upon completion;(c)the Homeowner understands that construction as contemplated by this agreement creates a dangerous condition,and agrees not to enter portions of the Property under construction until the Contractor advises the Homeowner that the construction is completed;(d)Contractor may need use landscaped areas of the yard during the Work and Homeowner is responsible to provide protection for landscaping and(e)that code requirements may result in roofing nails penetrating through roof decking and will be visible on the underside of some surfaces.The Homeowner indemnifies,exonerates and holds harmless the Contractor from any loss,damage,claim,liability or expense(including reasonable attorney's fees,deposition costs and court costs)resulting from a breach of this provision.Contractor is not responsible for damage to landscaping that will grow back during the next growing season. 10.CANCELLATION:Homeowner may cancel this agreement provided Homeowner notifies the Contractor in writing at the address listed in the Proposal not later than midnight of the third business day following the signing of this agreement. HOMEOWNER: DATE: Shingle: DEPOSIT: � � m The Cominonivealth of Massachusetts r Department of InditstrialAceidents Office of Invesagations 600 Washington Street Boston, AM 02111 -`� wov.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors[Electricians/Plumbers Applicant Information Please Print Legibly Name(Basin Organization/Individuai): /n /7,n 1 r Z=6, d�q P_ 1 i Address: 16T' City/State/ZipJ6640/ze� 10,534,- Phone#: Arey an employer?Check thea appropriate box: Type of project(required): 1_ I am a employer with 4. E] I a have e hired the sub-contractors a general contractor and I 6. E]New construction employees(full and/or part- e).* listed on the attached sheet. 7. ❑Remodeling ?.FJ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [Ivo workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions re 3.❑ I qu a homeowner doing all work officers have exercised their 11.0 Pit ing repairs or additions am myself.[No workers'camp. right of exemption per MGL 12. l oof repairs insurance required.]a c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 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[tire outside contractors must submit a new affidavit indicating such. }Contractors 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 attt an employer that is providing workers'compensation insurance for rn}1 employees. Belot,is the policy and job site infdrination. Insurance Company Name: / (��� !�/" .5'l� ell — Policy r or Self-ins.Lic.n• /.l" ^ Expiration Date: Job Site Address' -�) City/State/Zi Attach a copy of the workers'co ensation 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 imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foam 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. I do hereby certi ut r the pains and penalties of perjury that the information provided above is trne and correct. Simiature: Date: 46 r 1 Picone 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 n: ® OATE(MMlDD1YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/18/2016 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 pollcy(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 NAME:CT Diane LeBlanc DOHERTY INSURANCE AGENCY INC PA E,119 HONE (978)475-0260 FAX No AE-MAILDss: dleblanc@dohe insurance-com P.O BOX 1985 INSURERS AFFORDING COVERAGE NAIC 0 ANDOVER MA 01810 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: DAMPHOUSSE ROOFING LLP INSURERC: j INSURER 0. 87 BELMONT STREET INSURER E. NORTH ANDOVER MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER: 45466 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 LTR TYPEOFINSURANCE A L POLICY NUMBER MIDD SUBR EFF PMIDO EXP LIMITS COMMERCIAL GENERALLIABILRY EACHOCCURRENCE S DAMAGE CLAIMS•MADE EJOCCUR PREMISES EaEa oocwronce S T_ I MED EXP(Any one person) S N/A I PERSONAL 8 ADV INJURY S GEKL AGGREGATE LIMIT APPLIES PER: Jf j GENERAL AGGREGATE I S R POLICY❑JECTPRO ❑LOC I PRODUCTS I S -_ PRO- I OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT j s Ea accident ANY AUTO BODILY INJURY(Per person) is ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) S NON-OWNED PPROaEER DAMAGE S HIRED AUTOS AUTOS IS - UMBRELLA LU►B OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE NIA AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION /� STATUTE ER AND EMPLOYERS LIABILITY YIN ANYPROPRIETORMARTNEMEXECUTIV£ I E.L.EACHACCIDENT S 500,000 A OFFICERfMEAIBEREXCLUDE07 NIA NIA NIA AWC40070287742016A 04/17/2016 04/17/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If qes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101.Additional Romarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees 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 date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensatioainvestigationsi. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Andover MA 01810 Daniel M.Croey,CPCU,Vice President—Residual Market—WCRIBMA 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Client#- 14415 DAMPHOUSSE DATE ACORDN CERTIFICATE OF LIABILITY INSURANCE 04/18/2016YYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Bax 1985 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 21 Elm Street Andover,MA 01810 INSURERS AFFORDING COVERAGE MAIC# INSURED INSURER A Western world Damphousse Roofing LLP INSURER B: 87 Belmont St INSURER C: North Andover,MA 01845 INSURER D. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT.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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ROW TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DTE(MMMOfYYI DATE M Y LIMITS A GENERAL LIABILITY NPP8202847 04112/16 0412117 EACH OCCURRENCE S11,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE 70 RENTEDSES 1E. S100,000 CLAIMS MADE a OCCUR MED EXP(A ty one person) s5,000 PERSONAL&ADV INJURY S1 000 000 GENERAL AGGREGATE S2 000 000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000 X POLICY PRCOT• LOC AUTOMOBILE LtAOILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea acodentl ALL OWNED AUTOS BODILY INJURY � SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Por acc idem) PROPERTY DAMAGE S (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FiCLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND WC STATU• 0TH• EMPLOYERS'UABILITY ANY PRO?RIETORPARTNEWEXECUTIVE E.L.EACH ACCIDENT S OFFICERMEMBER EXCLUDED? El DISEASE-EA EMPLOYEE S If yes describe under SPECIAL PROVISIONS below E.LL DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Covering operations usual to Damphousse Roofing LLP... CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRE NTAT ACORD 25(2001108)1 of 2 #S33484/M33480 ML eIA60RD CORPORATION 1988 Mi. Massachusetts Department of Public Safety } Board of Building Regulations and Standards License: CS-067560 Construction Supervisor SHAUN M TWOMEY ` 61 PATROIT ST NORTH ANDOVER MA 01845 _/1l"�^ Expiration: Commissioner 10/25/2017 - Office of Con ume Affair&g;(cinegh HOME IMPROVEMENT CONTRACTOR r _ Registration: .174377 Type: Expiration: -2/412017 ., LLP D HOUSSE ROOFING LLP'.;'.: SHAUN TWOMEY 87 BELMONT ST N.ANDOVER,MA 01845``: Undersecretary