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HomeMy WebLinkAboutBuilding Permit #049-2017 - 1353 SALEM STREET 7/18/2016 of t10RTlH BUILDING PERMIT q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION titsj �o Permit No#: 1— �� Date Received A 7RA�R�TEo gSSACNUS�t Date Issued:a1a/ IMPORTANT: Applicant must complete all items on this page LOCATION 1353 Salmi SkrLcic- Print PROPERTY OWNER 5"c ICe, ge- Print 100 Year Structure yes no MAP PARCEL:_)ZONING DISTRICT: Historic District yes no Machine Shop Village yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial XRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain p Wetlands [I Watershed,District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Waakt�x�2 attor� : a;k S e.aA Zn a insWA_tf on o f dAhc a CU5-5 • 16-Aii141fen of A WC &4iskiha baAAmm Tins a,hcn oP dVwhana aaraa� Ceiling Identification- Please Type or Print Clearly OWNER: Name: TuUt_ KgLg,&, Phone: (-7M)ZSTr-o-asb Address: k3 S 5 o a S' Contractor Name: Nlkclno-LA 5ov Phone: (338 39Z-26M Email: m.. c Address: l0 o3 to? Supervisor's Construction License: CSSL- Iow%BS: Exp. Date: -7 17-6 18 5 Home Improvement License: k$2T9Z Exp. Date: 71VI/Zorl 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: $ 21 134.34 FEE: $ ??b Check No.: I -� ' Receipt No.: NOTE: Persons contracting with unr gistered contractors do not have access to the gu ranty fund 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 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. 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) 4. 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 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 Doe:Building Permit Revised 2014 I 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.OFF ICEUSE ONLY INTERDEPARTMENTAL SIGN OFF e 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 Plat--ening Board•Decision: ' ` Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW'Town Engineer.: Signature: Located 384 Osgood Street i�FIREDEPARTINEN Tjem .Dumpsterorisite; eyes `• ,.. _ ~"I t,Loc tedat�1�24MainfSt�eet. Fal 0-- t s COMMEf\ITS - - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of(Neter 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) Ll Notified for pickup Call Email Date Time Contact Name ----- -- Doc.Buildin;Permit Revised 2014 BUILDING PERMIT of NORTly q 6 TOWN OF NORTH ANDOVER ;.< APPLICATION FOR PLAN EXAMINATION t A Permit No#: I �it�l I Date ReceivedJ��Q - •,�'�y Date Issued: �SSRC HUS�t I PORTANT:Applicant must complete all items on this-nage LOCATION 1353 SAWLY\ Skr e - Print PROPERTY OWNER 37" Print 100 Year Structure yes no MAP PARCEL:_ ` ZONING DISTRICT: Historic District yes no Machine Shop Village 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 11 Other e : DESCRIPTION OF WORK TOoBE��{rPERFORMED: R.0. ,n9 0.ktor� ' at k s e.a Una i t � i o OF dA C a c eels • VVA il&tfnn_dF OY Identification- Please Type or Print Clearly OWNER: Name: IT"g- Mo EA. Phone: NO ZSFs oz% Address: g skril oro S Contractor Name: BkckcLeA 5d Phone: Email: ' Address: 10 0 3 107- Supervisor's Construction License: CSSL- Io .n3,r Exp. Date: '911 / 2612 Home Improvement License: k%270l2 Exp. Date: 7 1 2 Za ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2- , 13L4. 34 FEE: $ � � � Check No.: Receipt No.: 3b�7>1 NOTE: Persons contracting with un r gistered contractors do not have access to the gu ranty fund Mull U&IN41i �..__ < _ ,;,:.�.�tisr<er�...�•�.nfir.nsa vse�,*.�^.m^..es ^___.. . .__ .. _.._._.. Location No. LACA-�,+JlDate1 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee . Other Permit Fee $ TOTAL $—' Check# Building Inspector t NORT#i oven of 2 _ ndover O No. 6q9..,2001 H.c..eh ver, Mass, .Q cocw�cw '�' A°RAtEC' ►Pa`,��(5 S U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT � .. �� .. ......................................................... BUILDING INSPECTOR Foundation has permission to ere t ..... buildings on ........�. ... � ..II ..................... ......... ....... % Rough to be occupied as ... .�� . . ... . ...ami! .�.. . C......Ames .. ...... Amesno Chimney provided that the person accepting this p hall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and y-L s elating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. �� a.f, o PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. tl Rough � Final PERMIT EXPIRES IN 6 MONTHS Iit , ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service .. ... .. ...... ...... Finalai6UIED61iN�,G�ii PEC OR. GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i Federal to M 05-0405629 RISE Engineelring RI Contractor Registration No 8186 A division of Thielsch EngineeringMA Contractor Registration No 120979 RISE ENGINEERING Company Address,City,111ADODDD CONTRACT 401-123-1134 AX401-123-12M ,Y 1�1► Page 1 _. PROGRAM MS CONTRACT M gtr n Omi BETvrt�Tr RtsE CMA-HES EHGutEERINGAND T"11 tusTOMER FOR wYORx AS DESCRIBED BELOW CUSTOM plrOrllE DATE CLIENTS wwoRR ORDER Julie Keefe Y j (781)258-0356 05/27/2416 432474 00004 SIEFIVM STREET BILLING STREET 1353 Salem Street _N c 1353 Salem Street ca jjj..JJJ SERVICE CHY,STATE,$) BtLUNQ CITY,STATE,ZIP North Andover,MA 01845 Notch Andover,MA 01845 AN gnic Ll U DESCRIPTION AIR.SEALING:Provide labor and materials to seal areas of your home against wvasicful,excess air leakage. This work will be performed in concert with the use ofspecial tools and diamostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quaalit_.Materials to be used to seal your home can include caulks,fog and other products. Primary areas for scaling include air leakage to allies,basements,attached garages and other unheated meas(windows are not generally addressed)This will require(3)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the xv+ather'Lrntion work,and at no additional cost to the homeowner,a final blower door and/or corabustion safety analysis will be conducted by the sub-contmetor to ensure the safety of the indoor air quality. 5255.00 STORAGE BARRIER:Homemvner is responsible for the removal of the stored items blocking the installation of wcatherindion work in dic attic_ Removal roust occur prior to the schalulcd.work start $0.00 ATl7C ACCESS:Provide labor and materials to insulate(1) back of the kneeivall hatch with 2"rigid Thermax board,and mal the edge oflhe hatch with w eatherstripphi& $60.00 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2°rigid Thermax board and seal the door's edge with weatherstripping to restrict air leakage. 57222 VENT1LA77OA:Provide labor and materials to install(])insulated exhaust hose with gable wall mounted flapper vent to exhaust cxistirtg bathroom fan(s). 5118.75 VE"LAT10A1:Provide labor wW materials to install(10) 6"X 16"rectangular aluminum soffit vents to inrreasc ventilation in attic areas, Specify color.►kite or Gray. S250.00 COMMON H'AL1S:Provide labor and materials to install 2"FSK fared semi-rigid fiberglass board insulation to(112)square feet of common wall arra $392.00 OVERHANG:Provide labor and materials to install 9"R-32 densely packed Class I Cellulose insulation to(56)square feet of exterior overhang 1ocatcd below a heated floor area,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be scaled with exterior geode spackle and tell in a relatively smooth condition.Finish sanding and touch-up priming/paiming will be the cuslomeYs responsibility. S221.20 GARAGE CEiUNQ:Provide labor and materials to install 9"R-32 densely packed Class 1 Cellulose insulation to(572)square feet of garage cciling located below a healed floor ani,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be spackled and fell in a relatively smooth condition.Finish sanding and touch-up primina/painting will be the customer's responsibility. $1,138.28 RISE Engineering will apply all applicable,eligible incentives to this contract. You mill only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed S2,00 per calendar year,and an incentive of 100%for the Air Sealing measure up to the first$680 and an additional S340 if savings arc justified by die auditor. Federal ID 9 054405629 RISE Engineering RI Contractor Registraton No 8186 ! MA Contractor Regtst on'No 120979 RISE .�✓,,,. A division of'1'hiefsch Engineering I Company Address,City,AIA 00000 CONTRACT 401-123-1234 FA.X 401-123-1234 Page 2 PROGRAM TM CONTRACT IS ENTERED URO DEWEEII RMA CMA-HES ENGINEERM 0 AND TW CUSTOMER FOR VMRK AS DESCRIBED BELOW =TOWER PHONE DATE CLIENT a n1m ORDER Julie Keefe (731)258-0356 05/27/2016 432474 00004 5ERYICE STREET BUM STREET 1353 Salem Street 1353 Salem Street BFRNCE CITY.STATE ZIP MUMG CITY.STATE MP North Andover,MA 01845 North Andover,MA 01345 JOB DESCRIPTION For a limited time,Columbia Gas will also offer an additional S 100 incentive towards the weathcrization work outlined in this proposal.This special Summar Incentive is available to homvmiwis who have had theirColumbia Gas home energy audit before July 31,2016. A signed proposal for weatheriztion needs to be submitted by August 8,2016 and wort-must be completed by September 30.2016- For the safety and health of your homes indoor air quality,RT:will be conducting a blower door diagnostic of the available air flow in your home bout before Litt work is begun,and after the weatherization wort;is complete.We will also conduct a full assessment of the combustion safety of your beating system and water heater.This has a value ofS90 and is at no cost to you. The maximum allowable incentive for all measuses,including air sealing.is 53,210 $190.00 RISE Engineering wilt apply a credit ors I oo to%vardss this contract,in acknemdedgeInent of the deposit you made to Nest Step Living towards lrour original ieathcrization cw=L $0.00 EOV ,JUN1 - 7 2016 - Total: $2,697.45 Program Incentive: $2,134.34 Customer Total: $563.11 WE AGREE HEREBY TO FURMSH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***f=ive Hundred Sixty Three&111100 Dollars $563.91 UPON FINAL DTSPEcTtou AIA APPROVAL,BY JUSE ENG9(EB3M COSTOKER AGREES TO REMIT AMOLM RL$of FUU-INTEREST OF IS Y&L DE CIMROM MOIITHLY ON ANY UNPAID LO DAYS.Sr$Bg FOR aupo"AuT K-DRMATM ON GUARANTEES,(LIGHTS OF REMKK 309WAlNG,AND CONTRACTOR REGISTRA-0 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES A •WE E991rlv" ACC�TANCE:. NOTE;TMStONTRAC'Y IgAY EE WmG%LAYm B7 us ff NOT E%ECUTED VnMIN DATE OF ACCEPTANCE -- ACCEPTANCE of L entACT-THE ADOVE PRICES.smcw=noris Am comMMITS ARE 30SAIUFACTORY TO US AARE HEREBY ACCEPTED YOU ARE AUTHORTO TLD THE WORK DT*�• TA EPED AS SPEC*WM.PAYMENT WaL BE MADE AS OUTUNED ABOVE r J a RISE ' 60 Shawrnut Sparc,Unit 21 Canton,MA 020211339-502-6335 ENGINEERING- www.PJSEengineering.com OWNER AUTHORIZATION FORM i (owner's name) D owner of the property located at, JUN - 1 2016 (Property Address) (Property Address) hereby authorize m rii Ehgeom (Subcon ctor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. es Signature-,," Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street '+ Boston,MA 021.11 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Tndividual): Mill City Energy,LLC Address: P.O.Box 6411 City/State/Zip: Manchester NN 03108 Phone#: 603-391-7923 Are ou an employer?Check the appropriate bog: Type of project(required): I. I am a employer with 6 4• ❑ I am a general contractor and l employees(full and/orpart-time).** have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.[ 9. [�Building addition required.] 5. ❑ We area corporation and its I0.❑Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself.[No vaorkers'comp. right of exemption per MGI. 12❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.W Other WQAMp &—a cKoh comp.insurance required.] *Any applicant that checks box#1 must also fillout 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 state whether or not those entities have employees. Tf the subcontractors 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 informatiort. Insurance Company Name: Liberty Mutual Insurance Policy 4 or Self-ins.Lic.4: WC5-31S-391202-025 Expiration Date: 7/25/2016 Job Site Address: 1353 S&Lem Shaul City/State/Zip: No&N AtNddYA(',, m 01$yr 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. I do hereby certify un a its and penalties of perjury that-the information provided above is true and correct Si afore: Date: I Phone 9: 603-391-7923 Official use only. Do not write in this area to be completed b city or lawn official. I ff y� p Y 0' ffl 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.Qther Contact Person: Phone#: The Commonwealth of Massachusetts ' Department of IndustrialAccidents I Congress Street;Suite 100 Boston,.MA 02114-2017 I• www.massgov/dia Wormers'Compensation insurance Affidavit:General Businesses. TO BE EXILED WITH THE PERMITTINIG AUTHORITY. Agpiieant Information Please Print Legibly Business/Organization.Name:Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester,NH 03108 phone#.603-391-7923 Are you an employer?Check the appropriate box: Business Type(required): 1.®✓ I am a employer with 12 employees(full and/ 5. ❑Retail or part-time).! 6. Restaurant/Bar/Eating Establishment 2. I am a sole proprietor or partnership and have no 7, Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] $• ❑Non-profit 3.0 We are a corporation and its officers.have exercised 9. [l Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]* 1 i.©Health Care y 4.❑ We are a non-profit organization,staffed by volunteers, with no employees.[No workers'comp.insurance req.] 12.5fl Other W�I�OOn *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. ."lf the corporate officers have exempted themselves,but the corporation has other employees.a workers compensation policy is`required and such an organization should check box#1. I am an employer tliat is providing ivorkers'con+peitsatio+i insurance for my empkvees. Be&nv is the policy information. Insurance Company Name:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N T City/StateiZip: Manchester, NH 03102 Policy#or Self-ins.Lic.#MIWC791896 Expiration Date:4/29/2017 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 ofthis statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. v' v true and correct. I do hereby certif r,tr ins and peau/ties ofperjury that the information pro ztle�above Signature: Date: 7/.Z.Q i_a(I u.603-396-7520 1 Phone n. Official use on1y. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): E.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wiv%v.mass.govidia � I �� r1 MILLCITY-1 AGOULD '4�oRo9 CERTIFICATE OF LIABILITY INSURANCE DATE F 7/119/219/2016 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 License#AGR8150 CONTACT Clark Insurance NAME:PHONE FAX One Sundial Ave Suite 302N A/c No Ext):(603)622-2855 AIc No): (603)622-2854 Manchester,NH 03102 AIL ADDRESS:agould@ciarkinsurance.com ti INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Co 17000 INSURED INSURER B:AmGuard Ins Co 43290 Mill City Energy INSURER C: 106 Joseph St PO Box 6411 INSURER D: Manchester,NH 03102 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 8500065735 04/29/2016 04/29/2017 PREMISES Ea occurrence $ 300,000 AMAGE TO RENT MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED7XRETENTION$ 10,000 $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER hV B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 l OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I AC's CERTIFICATE 8/6/200 TE OF LIABILITY INSURANCE DATE/6/2015 8/6/ .15 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 endomement(s). PRODUCER CONTACT Sarah-Lauersen NAME: 843 Slawsby Insurance Agency PHONE tg00)258-1776 AlC No:(603)429-- 3 .Mound Ct, Suite B ADDOORESS:slauersen@minutemangroup.com PO BOX 1807 INSURE AFFORDING COVERAGE NAICIf Merrimack NH 03054-1807 INSURERA.Liber Mutual INSURED - INSURER 8: - Mill City Energy LLC INSURER C: PO Box 6411 INSURER D: INSURER E. Manchester NE 03168-641.1 1 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-2016 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. ILS POLICY EFF POLICY EXP UhtlTS TYPE OF INSURANCE POLICY NUMBER MMfD M COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE_ $ SEE $CLAIMS-MADE0 OCCUR nceson) $ PERSONAL&ADV INJURY S GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ Jr LOC PRODUCTS-COMP/OPAGG $ 3 OTHER: AUTOMOBILE LIABILITY F,accent LE I $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS NON-0WNED PROPERTY DAMAGE Perecciderrt $ HIREDAUTOS AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIM'MADE AGGREGATE $ S ER DED RETENTION OT WORKERS COMPENSATION S UTE ER AND EMPLOYERS'LIABILITY ANY PROPRIE70RIPARTNER/EXECUTIVE YIN NIA E.L.EACH ACCIDENT $ 500 000 OFFICERMIEMBEREXCLUDED? F WC531S391202-025 7/25/2015 7/25/2016 E.L.DISEASE-EAEMPLOY $ 500 000 (Mandatory in NH) If yes,desatbe under E.L DISEASE-POLICY LIMIT S 500 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERATIONSI LOCATIONS I VEHICLES(ACORD 101,Addttlaml Reriarks Schedule,may be attached If more space is requlted) CERTIFICAfE 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 --�, David Herod/SARAH _ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS026(201401) I i a Massachusetts Department of Public Safety Board of Building Regulations and Standards License:.CSSL-106035 Construction Supervisor Specialty MICHAEL JOY 106 JOSEPH STREHTI tip ^ MANCHESTER NH 03102x,. -� '.trk -ten CA Expiration: Commissioner 08107/2018 ns er Affairs&Bu i Cis Regulatirurcl/a License or registration valid for individul use only Office of Consumer Affairs&Ausi�ess Regulation g y ' OM E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �egistration: .f82792 Type: Office of Consumer Affairs and Business Regulation xpiration 7127/2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 MILL CITY ENERGY LLC;, r. MICHAEL JOY 106 JOSEPH STREET MANCHESTER,NH 03102 . Undersecretary N va I ithout si ure r