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HomeMy WebLinkAboutBuilding Permit #177-2017 - 13 MAPLE AVENUE 8/19/2016 NORrN BUILDING PERMIT o� q TOWN OF NORTH ANDOVER tiED ti APPLICATION FOR PLAN EXAMINATION '- Permit No#: Date Received ,]° - tt 14Q°N t7ED PPy�S Date Issued: 1�._ .� �SSgCHus�� IM TANT:Applicant must complete all items on this page LOCATION AYE - PROPERTY OWNER r4 , 'A ,Print Print J 100 Year Structure :ye no MAP_ l�PARCEL: �� ZONING DISTRICT: Historic District s noMachine Shop Villages no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 11Commercial ElRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p ❑ Septic ❑ Well _ _ ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: c7 it W CK LAtiDs N C� '�� ,Qti� �'1 A i DUC. ANb =Aa7ALec N Allq 'Co Ant is c'%W\cj. 1 I Identification- Please Type or Print Clearly OWNER: Name:- ::7-1 M �61ZIet n1 � Phone: Address: 11 q Contractor Name:1 m Q Phone: q'� 'I I I 1 Email: i,DA1�l3R�Co e�M I� `conn iill'f I `Z 06AMEeL Fy RD t\1viry it A N bovF a s�tA Supervisor's Construction License: i 10I Exp. Date:_�� ►��' -� i Home Improvement License:_ 1684,1 Exp. Date: i ARCHITECT/ENGINEER Phone: Address: C Reg. No. � FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS BAED ON$125.00 PER S.F. Total Project Cost: $ •p o FEE: $ "! Check No.: Receipt No.: -�6-7L51 NOTE: Pe ons contracting with unregistered contractors do not have access to the guaranty fund L _ -- - _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning 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 e U FORM PLANNING & DEVELOPMENT Reviewed On ����� Signature_ COMMENTS 41�,,.d� i CONSERVATION Reviewed on '> l ' I Si natur COMMENTS HEALTH Reviewed on Signature COMMENTS Bening Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Hanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located_ 384 Osgood Street FI_RE�DEPARTIVIENT; Temp Dumpster on*site gosY . _ _ _ ,r o _ �_ T _ - Located�af 12,4 Maoiaaeet- Fire�Depar'itmenf�rgnature/date: COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL. Movement of I+,llleter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Suilding Pennit 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 I 4, Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract I Floor Plan Or Proposed Interior Work 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 } Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) j 1 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 k 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 m ust 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 ElTanning/Massage/Sody Art 11Swimming 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 m U FORM PLANNING & DEVELOPMENT Reviewed On 1Signature_ COMMENTS Iq 4 CONSERVATION Reviewed on ' ` [ (Z7 Si nature-' COMMENTS 1 � HEALTH Reviewed on Signature COMMENTS e 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 FIRE D.EP`ARpTrMENTT,`�ernp ®um suer onslfe- ,y�es . . .. _ o � - Lrocat124tMamStreet FireiDepartment Igna#ureldate _ •�SS,,•,,,,x.' 3'l t..r 4r.x i' .�.,{ ,., ,`` �`?� w.,._T.�F���k a.�f�K�"s'i'..E�r"�'-sip^?'.. T7`-.�fx i°'� :#.p�«r :.t �� a CZ'Vii. NORTH Town of 2 t _ s ndover O ry M No. 4Id Rip- IL b h ver, Mass, 1.0- OL lei P) AOR�COC MICN.WICK TEO I.P s U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......q.,;.W%... %C .......................... BUILDING INSPECTOR has permission to erect .......................... buildings on ... Foundation..... . . .. . . ie Rough to be occupied as .. . C►�.�r..... .. ....� .... ....�i`�1�.................................. Chimney provided that the person aceptin this ermit shall in eve s ect conform to the terms of thea licationg pp pp 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 CTIO Rough Service ...... ............ ...... Final INSPE OR 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. I Bri* Co. Building&Remodelin Adam Brien CSL 104428 417 Waverly Rd. HIC 168512 North Andover, MA 01845 LLC 978-479-1526 8/16/16 adambrico@gmail CONTRACT Jim Selfridge North Andover MA Job Description 1: Rear exterior stairs and landing replacement: • Replace existing 4x6 landing and back stairs. Deck size and location to remain exactly the same as existing. • Temporary supports installed to hold roof above in place. • Demolition of existing structure and removal of concrete step. Debris to be trucked off site. • 2-10" sauna tubes dug and filled with concrete. • Deck framed with PT lumber build to state building code. Stairs installed and finished on new 6" concrete pad. • 4x6 fur posts installed to support roof above. • Decking material to be composite "Wolf" WEATHERED IPE, Railings to be white PVC material. • Underside of deck to be PVC material and lattice, columns to be wrapped with PVC material. Gate door framed and installed • Permit fee included • Painting not included Total Estimated Cost$5,300.00 Additional Repairs to front deck to be billed as T&M, to men at$85.per hour plus material Deposit of$1,500.00 due at contract signing for permit fee and special order decking. All subcontractors that are hired by BriCo or the homeowner must carry the appropriate license and insurance to perform work in the state of Massachusetts. The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices, and all work performed shall be subject to final approval by Owner. All work to be done incompliance with Massachusetts building code. BriCo takes on full responsibility of all necessary inspections. All craftsmanship is warrantied for one full year from completion of construction. Warranty is voided if repairs are necessary due to a natural disaster. All glass installed meets state energy code for performance and efficiency. Each glass unit will contain its own energy certificate. Any unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any extra work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. BriCo is not responsible for anything that occurs on site that is not directly involved with the construction of this project. BriCo Building and Remodeling is a fully licensed and insured LLC company. License numbers are provided in the header above and current insurance documentation upon request. � J � s z ST'o Ky It•..7o. c 3 P a $Lc" MA LE AV Et\1 U E ;'�"•jam J�i���� 'LOCATION OF STRUCTURES) BASED ON tJNE$OF OCCUPATION ONLY. AMORE ACCURATE LO 11 SURVEY WILL REQUIRE AN INSTRUMENT Scale: PROFESSIONAL LAND SURVEYOR. O HEREBY CERTIFY THAT THE AMERICAN SURVEYING COMPANY BOVE MORTGAGE INSPECTION 1264 Main Street, Waltham, MA 02451 (781) 693-6477. LAN WAS PR PARED FOp PREPARED FOR INTEGRATED MORTGAGE 8ERVIM,INC. ONNECTION WITHA NEW MORTGAGE �/� - ND IS NOT INTENDED OR REPRE- Mortgage Inspection Plan ENTED TO BE A LAND OR PROPERTY NE SURVEY. NO CORNERS WERE THE LOCATION OF THE ORIGINALRECORD COUNTY REGISTRY OF DEEDS ET. IT ICANNOT BE USED FOR ES- DWELLING SHOWN HEREON EITHER BOOK —PAGE ' C.Cert tt 4BLISHING FENCE, HEDGE OR WAS IN COMPLIANCE WITH THE LOCAL PLAN REFERENCE: L.��• e JILDING LINES.THE LAND AS SHOWN APPLICABLE ZONING BYLAWS IN EF. DRAWN PER TOWN OF ASSESSORS EREON IS BASED ON CLIENT FUR- FECT WHEN CONSTRUCTED WITH RE• MAP# PARCEL!! DATED ISHED INFORMATION AND MAY BE SPECTTO HORIZONTAL DIMENSIONAL ADDRESS: hlPge JBJECT TO FURTHER OUT-SALAS, REQUIREMENTS ONLY),OR IS EXEMPT �V WINGS,EASEMENTS AND RIGHTS OF FROM VIOLATION ENFORCEMENT AC- BORROWER: t 'AY. = RESPONSIBILITY IS EX- TION UNDER MASS.G.LTITLEVII,CHAP. --NDEDHEREINTOTHE LANDOWNER 40A, SEC. 7, UNLESS OTHERWISE SUBJECT DWELLING UES IN FLOOD ZONE R OCCUPANT. IT IS NOT INTENDEDI NOTED OR SHOWN HEREON. A CON-JAS SHOWN ON NATIONAL FLOOD 1N$URANCE PROGRAM FLOOD Dagle Electrical Construction Corp. JOB P.O. Box 760982, Melrose, MA 02176 SHEET NO. CF Tel: 800-379-1459 / Fax: 781-937-7678 CALCULATED BY DATE oE�C� E-mail: dec@deccorp.com CHECKED BY DATE Local.103 IBEW www.deccorp.com SCALE ' a , - {. I .... _ __.... MAX x t � _ w _ ...... - - i 717 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UT. 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):-ZE e O 15 ,l i 9%/moi-( + Il t:1�14��LdthLG V Address: L.E 1-T hLu a LFi. : &t) City/State/Zip: K A#,bnVk A, MA cas _ Phone#:_ 15,,)( Are you an employer?Check the appropriate box: Type of project(required): 1.L& I am a employer with _/1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• N Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E]Electrical repairs or additions 3.E3 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]T employees. [No workers' 13.[1 Other 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. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:r,RVG LX__C S Policy#or Self-ins.Lic.#: .� �3 y(7�$ (�S p`j 16 Expiration Date: l rf !Z01-1 Job L 1Job Site Address: j?i MNIPLZ AVE h&m-rw AN Isoy t City/State/Zip: rVlA ©r1b 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 imposition 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. Ido hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Signature: 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#• AC�® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/11/2016 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 NAME: Trudy Lawler MICHAUD INSURANCE AGENCY AICNNo Ext: (978)685-2549 n/c No: E-MAIL ADDRESS: trudylawler@michaudinsurance.com 105 HAVERHILL ST. INSURERS)AFFORDING COVERAGE NAIC# METHUEN MA 01844 INSURERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: BRICO BUILDING&REMODELING LLC INSURER C: INSURER D: 417 WAVERLEY RD INSURER E: N ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 67853 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. ILTR TYPE OF INSURANCE ADSL SUER POLICY NUMBER MM/DD MEFF POLICY WDI D EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FIOCCUR DAMAGETO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT F—]LOCPRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION XI PER STATUTE ETH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? NIA NIA NIA 7PJUB4618P50716 04/19/2016 04/19/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe 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.govfwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845LL� Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY IN � SURANCE 7/11/16 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(!as) 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 thl s certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT Armand P. Michaud Insurance PHONE Tricia Sabulis FAX 105 Haverhill Street �g fA1C N 978 685-2549 NI: (978) 794-0822 E-MIL Methuen, MA 01844 ADDRESS: triciasabulis@michaudinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Green Mountain Insurance Co. INSURED INSURER 8:Norfolk & Dedham MA BRICO Building & Remodeling LL INSURER c: Adam J Brien INSURERO: 417 Waverley Rd INSURER E: N Andover, MA 01845 INSURERF: 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 AML SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDY MN/DO/YYYY LIMITS A GENERAL LIABILITY 20009201 4/13/16 4/13/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TORENTED $ CLAIMS-MADE a OCCUR IVIED EXP(Anyone person) $ 5,000 PERSONAL&ADVINJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,060 POLICY PRO.- LOC $ECT F B AUTOMOBILE LIABILITY91561617A 6/18/16 6/18/17 COMBWNEDdSINGLELIMIT $ ANYAUTO BODILY INJURY(Per parson) $ 100.000 ALLOWAUTOS NED SCHEDX AUTOS BODILY BODILY INJURY(Per accident) $ 300,000 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS araccident 100,000 $ UMBRELLALIAB F OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOWPARTNER/E XECUTNE OFFICER/MEMBEREXCLUDED? N/A E.L.EACHACgDENr $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTIO N OF OPERATIONS below E.L.DISEASE-POLICY L IM IT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rernaft Schedule,if more space Is regd red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Tricia Sabulis ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: (978) 685-2549 Fax: (978) 794-0822 E-Mail: triciasabulis@michaudinsurance.com i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-104428 Construction Supervisor ADAM J BR IEN 417 WAVERLY ROAD NORTH ANDOVER MA 01845 w Expiration: commissioner 05/12/2018 ...fie�pom?/n2oaz�/lea,GGla O�C%l�Gcao6a,Ctarc6e�;s.; 'Office of Consumer Affairs&Busfrtss Reguiaticu, s 4 OME IMPROVEMENT CONTRACTOR i egistration: `168512 Type' t Expiration-A3117-20_1_7 ,y LLC BRICO BUILDING ANII REMODELING LLC QR.ADAM BRIEN `rte 417 WAVERLY RD NORTH ANDOVER;MA:01$45 Undersecretary. Location 1-3 £ �`v e" No. m — 2 o i Date • - TOWN OF NORTH ANDOVER 4, Certificate of Occupancy $ Building/Frame Permit Fee $ h — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1 /69 Building Inspector(/