HomeMy WebLinkAboutBuilding Permit #675-2017 - 14 INGLEWOOD STREET 12/28/2016 VkORTF/
rr/ BUILDING OERMIT
v I TOWN OF NORTH ANDOVER ° 40w,0
PPLICATION FOR PLAN EXAMINATION i . a �*
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Permit NO: ` Date Received �-O t °
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Date Issued: 1 Z ' �r ACHU
IMPORTANT:Applicant must complete all items on this page
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4PROPF 2TY OWNEF2 .
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-1v NO.:- .J—. f PARCEL ZONING DISTRICT _Historic Djstrict yds no
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Ah
F 70
� _ _ __ ' � Machine �hoptl/illge� Yes :no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building KOne family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
XRepair, replacement ❑Assessory Bldg ❑ Others:
0 Demolition ❑ Other
i 1 Faliod Iain t Wetlands illUatershed l3�strict
G3 Sep ;1Nell p -41
_CI�lVater/S,evver 1 '
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Identification Please Type or Print Clearly) /�
OWNER: Name: rPhone:,N/` -�`` �a
n
Address: i ��cl`��' Ak
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CONTRAC d Name - - Phone
Address -
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-
Su erwsor s _ onstruction Lacense Exat � =
�. � 2
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Home lmprovemnt license Exat
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{ -
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: $ ob tl FEE: $ A
Check No.: � Receipt No.: t '
NOTE: Persons contracts w e contractors do not have access to th g Vnd
ignature of contactor
L
ItORT�j
BUILDING F'CRMIT oF�sLEo ,6q.
TOWN OF NORTH ANDOVER - -
APPLICATION FOR PLAN EXAMINATION '
Permit No#: Date Received 7 A�RHTEU,.4R�
�SSAC U
H
Date Issued:
IMPORTANT:Applicant must complete all items on this page
I
`�pa° `s _
I LOCATION — X®�`�`. ----- ��- '
_ y
PROPERTY ®WNER
DD earstructurevesAe
no
EMAP __'` PARCE L RICONINr?- DISTRICT His#ortcDistnct yes ,no
age -ye
{ :- UMac}ime Shop Vill ;�; 's no.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
11 Alteration
No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑Demolition ❑ Other
Septic. 'O V1/ef1 �.Floodplain WetCands 9 Watershed D►strict
E_INate_r/Sewer.
DESCRIPTION OF WORK TO BE PERFORMED:
r
y
a
a i
Identification- Please Type or Print Clearly-
OWNER: Name: Phone:
I -
Address:
Contractor Name:;_-: _ Ph _
-
Supervisor's Con struction;Licen -vr Exp: DateF 4;{ av fi
Home I=mprovement License:._. _ Exp Date s: i
ARCHITECT/ENGINEER Phone:
Address: Reg, No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
,Total Project Cost: $ FEE: $
Check No.: Receipt No,
NOTE: Persons contractinga with unregistered contractors do not have.deeds rio the guaranty fund
inr at �ir�>nfAr;Pnt/n�niilPr Signature of coiifractor
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
'ITPS"OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiirm;ng Pools El
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
.COMMENTS
g CONSERVATION Reviewed on Signature
COMMENTS
1
i
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Tomo Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -.Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureldate
COMMENTS
-)imension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
l
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, roast or service drop requires approval of
Electrical Inspector lyes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use) _
k
I
❑ Notified for pickup Call Email t
ate 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
❑ Engineering Affidavits for Engineered products
NOTE: 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)
❑ Mass check Energy Compliance Report (if Applicable)
❑ Engineering Affidavits for Engineered products
DOTE: 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
❑ Mass check Energy Compliance Report 1
o Engineering Affidavits for Engineered products
DOTE: 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
L�
Doc:Building Permit Revised 2014
Location J) 5 1
No. G Date F /.a f �-G 1
i
i
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $ ;r
TOTAL $
Check# UZQ f
7 Building Inspector
NORT11
own o : Andover
0 . :. w:: . 0
No. -
V.
h ver, Mass, / e 0/ 6
COC MIG 141 WICK y1.
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ... .... ..... ..0. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR
O
has permission to erect .......................... buildings on ..IM..111. ....
., . .......A......J.7.!........... Foundation
. Rough
to be occupied as ........�.........�� .�.� .............#...........e.^..1. ...f 1..... 0.�.. 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 Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO A TS Rough
Service
............. .. ..... ......... ... ................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
HOME IMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Furnished.and Installed by
THD At-Home Services,Inc..
Branch Name:New England Date -/Ib. li d/b/a The Home Depot At-Home Services
Branch Number:31 908 Boston,Turnpike,Unit 1,Shrewsbury,MA 01545
Toll Free 877-903-3768
Federal ID#75-2698460;ME I:ic'#C 02439,RI Cont.U10,16427
CT Lic it HIG.g565522;MA Home Improvement Contractor Reg.#126893
�i
Installation Address: o-I
City State Zip
Purchaser(s): Work Phone: Home Phone: Cell Phone:
Home Address',
City State �p
Of different from Installation Address)
E-mail Address(to-receive project communications and Home Depot updates
❑I DO NOT wish to receive any marketing emails from The Home Depot
Project Information: Undersigned('Customer'),the owners of the property located at the above installation address,agrees to buyi.
and THD At-Home Services,Inc.("The Home Depot")agrees to furnish;deliver and arrange for the installation("Installation") of
all materials described on the below and. on the ;referenced Spec Sheet(s), all.of which.are incorporated: into flus Contract by this..
reference, along vrith any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively;
"Contract"):
.loh tote BI Ger rcncei Products: Sec Sheet(s)#: Project Amount_
Roofing ElSiding Windows Lj Insulation � .Z? $
❑Gutters/Covers lAntry Doors ❑ (! 1
Roofing SidingLpvindows ❑Insulation q
q7 /'2_q q ❑Gutters/Covers ntry Doors F-1 -` 7 ` t t 7 6
❑Rooting, Siding U Windows El Insulation $
❑Gutters/Covers ❑Entry Doors
Roofing W.Siding ,Lj Windows insulation
❑Gutters/Covers ❑Entry Doors []
Minimum 25%Deposit of"Contract Amount due upon execution of this contract- Total Contract Amount $
Maine Purchasers may not deposit more than one-third of the ContractAmount
Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate
tone for each Product as defined by an individual. Spec Sheet)and pay any balance due. As applicable, each Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Products)included herein;at
its discretion,if The Home Depot or its authorized service:provider deterinines that it cannot perform its obligations due to a structural
problemwith the home,;environmental hazards such as mold: asbestos or lead paint,other safety concerns,pricing errors or because
work required to complete:.the job was not included in the Contract.
2 f`1d � included as art of this 'Contract. sets forth the total
Payment Summary: The Payment Summary #, � � P
Contract amount and payments required for the deposits and final payments byProduct`(as applicable);
NOTICE TO CUSTOMER
You are entitled to a completely filled4n copy of the Contract at the time you sign. Do not sign a Completion Certificate(note:.
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product
is complete.
In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,Labor,expenses
and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WI l'HHOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE; WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS..
Accentance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Home'Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements, either
oral or written,relating to said Products and Installation. TUs Agreement cannot be assigned or amended except bya writing.signed
by Customer and Horne:Depot. Customer acknowledges and agrees that Customer has read-, understands,voluntarily accepts the
terms of an w s rete'"eda copy oft Agreement.. t
i
HOME IMPROVEMENT CONTRACT'
For Massachusetts Residents Only
Contractor Arbitration:
The Home Improvement Contractor Law provides.homeowners .with the right to initiate an arbitration action (as an alternative to
court action)if they have a dispute with a contractor. However,. the same right is not afforded to a contractor. The contractor
would have'to resolve any dispute helshe has with a homeowner in court unless both partes agree to the optional clause provided
below. This clause would give the contractor the same rightto arbitration as is afforded to the homeowner by the Home
Improvement Contractor Law.
The 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 the dispute to-a private arbitration firm which has been approved by the
Secretary of the Executive is of Cons er Affairs and Business Regulation and the consumer.shall be required to
submit;to such arbitratio s i ed in acl u s Genera cbapter 142A
Homeowner Signa tpr Contractor Signature
NOTICE:The signature of the parties above apply to the agreement of the parties to alternative dispute resolution initiated by the
contractor. The homeowner may initiate alternative dispute resolution even where this section is not separatelsigned by both
parties. y
Homeowners Rights,
A homeowner's rights under the Home Improvement Contractor Law (MCL chapter 142A) and other consumer protection laws
O.e.MGL chapter 93A)may not be waived in any way, even by agreement However,homeowners may be excluded from certain
rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building
permits are automatically excluded from any Guaranty Fund provisions of the Home Improvement Contractor Law. The
contractor is responsible for completing the work as.described in a timely and workmanlike manner. Homeowners may beentitled
to other specific legal rights if the contractor guarantees orprovides an express warranty for workmanship or materials. in addition
to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry so implied warranty of
merchantability and fitness for a particular purpose. An enumeration of these matters on which the homeowner and contractor,
lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer's rights,
Execution of Contract: The contract must be executed.-in duplicate and should not be signed'until a copy of all exhibits and
referenced documents have been attached: Parties are also advised not to sign the document until allblank sections have been
filled in or marked as void, deleted or not applicable. One originalsigned copy of the contract with attachments is to be given to
the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both
parties.Contracted work may not begin until both parties have received a fully executed copyof the'contract.
Accelerated Payments: A=contractor may not demand payments in advance of the datesspecified on the payment schedule in
cases. where :the homeowner deems him/herself to be financially insecure. However; in instances where a contractor deems
him/herself to be financially insecure, the contractor may require-the balance of funds not yet due be placed in a joint escrow
account as a prerequisite to continuing the contracted work. Withdrawal of funds.from said account would require the signatures
of both patties.
Additional Information: That all home improvement contractors and subcontractors shall be registered and that any inquiries
about a contractor or subcontractor relating to a registration-should be directed to:
Office of Consumer Affairs and Business Regulation
Ten Park Plaza,Suite 5170
Boston,MA 02116
Phone:(617)973.8700
SUBMITTED BY: Date: {Z"i 6—14
Sale, nt
ACCEPTED BY: Date: (2--(0-14?
rcha.w
Purchaser
Dater
06-24-13 White—branch;File Yellow—Customer
WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9739298 Sheet: 1 of 1
Customer: Robert Stowers Job#: 9739298 Consultant: Leonard Racite Date: 12/10/2016
New Window
Existing Window Hinge Locations
Measurements Grids Product Options Labor Options From outside,
Left to Right
Bays,Bowls
Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl,
use L,R or S
Glass Misc Items
Hardware Code
Screens For doors use
o _p T o _p Mull "S"=stationary or
« = to A t) N a tJ N "X"=operating
w Style Wraps m a 0c 3 r r c
Room Floor Code (YM) Style Code Series Code S w 3 = 5 t-vi v a > xo 0 > x°
STD,GlassPack:Standard WRAP,LSR
1 LIV tat 84 Y S4 6100 WH WH 97.00 53.00 150 F.GBG WH,WH C ALL 1 3 ALL 1 3 L S S R
I
STD,GlassPack:Standard WRAP,LSR
2 SEW 1st OH Y DH 6100 WH WH 43.00 63.00 96 F,GBG WH,WH C ALL 3 1 ALL 3 1
STD,GlassPack:Standard WRAP,LSR
3 BED1 tat DH v DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH C ALL 3 1 ALL 3 1
STD,GlassPack:Standard WRAP,LSR
4 BED2 tat DH Y DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH C ALL 3 1 ALL 3 1
STD,GlasaPack:Standard WRAP,LSR
5 BED2 tat OH Y DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH C ALL 3 1 ALL 3 1
STD,GlassPack:Standard WRAP,LSR
6 KITCH 1st B3 Y B3 6100 WH WH 69.00 37.00 106 F,GBG WH,WH C ALL 1 3 ALL 1 3 L S R
SPECIAL CONSIDERATIONS:
Wrap Color WHITE
Interior Casing Type Colonial
Bay or Bow window:
eatboard material(vinyl only-Birch or Oak) Oak
ay Project Angle(30 or 45)
ay Flanker Type(DH,SH,or Csmnt)
op of window to soffit(Inches) 5
If tied to soffit,color of soffit material WHITE I have reviewed and agree with all the job specifications above and the
onstruct Roof(Yes or No)" Yes Special Terms and Conditions on the following page
Garden Window:
eatboard Material(vinyl only-White Plonite,Birch or Oak)
Wall Thickness(Inches) Customer Signature
Additional Shelf(Yes or No)
There is no guarantee that new shingles will match existing color.
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Tlie Conimonwealtli ofMassacllusetis
_ - Department of IndustrialAccidents
1 Congress Street, Suite IDU
Rncinr� 11/I t1-02114-2077
www mass.govAlia
1Vorkers'Compensation Insurance Affidavit:Builders/Cont[•actors/Electricians/Plumbers.
TO BE FiLED WITH THE PERMITTING AUTHORITY.
Applicant Information _ Please Print Legibly
Name (Business/Organization/Individual): J� {{f
Address: U ' 1
City/State/Zip:� >��L' 1i f} 9�1one 2--
Are you an employer?Check the appropriate box:
Type of project(required):
l.❑1 am a employer with employees(full and/or part-time).* 7. New construction
2.F�1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. ❑Demolition
4.[:]l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole 1 i.0 Electrical repairs or additions
proprietors with no employees.
I2.❑Plumbing repairs or additions
5,X1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.,* 13.❑Rof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14• Other_ /,1j��17/I/�
1521§1(4),and we have no employees.[No workers'comp.insurance required.] RVI?/-(
*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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation itisttraizce for my enzp/ogees. Below is the policy and job site
information. p 1 1
insurance Company Name:
Policy#or Self-ins.Lic.#: � '� 1 Expiration Date: 9t A
Job Site Address:
City/State/Zip
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do It eby cert—ife:,!Oet tan';.,ena ties of perjury that the information provided above is true and correct.
�!7
Signature: '��VL-1Date: — 2
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#:
ATE
ACC?RE-P CERTIFICATE OF LIABILITY ITY INSURANCE Do2n4rzo16DIYYYY)
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-
MARSH
ONTACT IvARSH USA,INC. NAME:PHONEFAX-
T14r0 ALLIANCE CENTER JAM. o A1C Noj:
3550 LENOX ROAD,SUITE 2400 E-MAIL
ATLANTA,GA 30326 ADDRESS:
INSURER SI AFFORDING COVERAGE NAIC#
100492-HorneD-GA^!'46-17 INSURER A:Steadiast Insurance Company 26387
INSURED HE HOME DEPOT,INC. INSURER B:ZuhncAmerican Insurance Co 16535
HOME DEPOT U.S-A.,INC. INSURER C:New Hampshire Ins Co 23841
s 2455 PACES FERRY ROAD;NIN INSURER D:111irlas Nalioral Insurance Coaipairy 23817
j BUILDING C-20
Tv�.!)TA;Ga 30K
INSURER
E-[
1
INSURER F:
COVERAGES CERTIFICATE NUMBER: ATL-OW741310-08 REVISION NUMBER:O
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 VVITH RESPECT TO WHICH THIS: 1
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i
ILXP
TR TYPE OF INSURANCE- S 6 POLICY NUMBER MMlDDPOLICYIYYYY MM(DDIEFFYIYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY GLO4887714-06 0310112010
03101/2017FACHOCCURRENCE �5I ,000I
DAMAGE-10
CLAIMIS-MADE OCCUR PREtAISES(Eaoccurr
ence) S 1,000.000
LIMITS OF POLICY XS (SED EXP(An;one person) 5 EXCLUDED
OF SIR:S1 h1 PER OCC PERSONAL&ADV INJURY S 5,000,000
(:-:Er-1'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4000,000
X- POLICY P_PRG C LOC PRODUCTS-COtiP10PAGG 5 9.0M,000
OTHER:
S
B AUTOMOBILE LIABILITY BAP 2y35863-13 �
! 03101/2016 03101/20/7 COMBINED SINGLE LIMIT S 1,OOO,C00 I I - _(Ea accident -
A i ANY AUTO + BODILY INJURY(Per person) S
ALL OWNED SCHEDULED 11 SELF INSURED AUTO PHY DVIG - BODILY INJURY(Per accident) S
AUTOS AUTOS _
NON-OWNED PROPERTY DAMAGE
HIREDA.UTOS AUTOS racciC nt S
5
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LIAR CLA11"AS-MADE1 AGGREGATE S
DED RETENTIONS S
- f WORKERS COMPENSATION r1:1CQ15;1921.5?AOS) 'OT012016 03101r0;7 ('TH-
AND EMPLOYERS'LIABILITY 1 'r ATUTL- ICR
C' ANY PROPRIETORIPARTNERIEXECUTIVE Y 1 N j %VC015519217(AK,KY,IJH,NJ,VT) 0310112016 03(01/2017 i pft(I,Ot;n.
OFflCER/MEMBER EXCLUDED? Id NIA E.L.EACH ACCIDENT 5
(Mandatory In NH) WC015519216(FL) 03101,2016 0310112017 E.L.DISEASE-EA EMPLOYE 5 1 0 ,000
Ilges,describe under Continued on Add,1=31 Pae 1,00D,000
DESCRIPTION OF OPERATIONS belay 9 E.L..DISEASE-POLICY LIMIT S
l
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
16000SGOODST- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
NORTHANDOVER.MA 0184,5 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
ivlanashi Mukherjee i Cciti�e r�- �;�tn• tc_rity e�
v 1988-2014 ACORD CORPORATION. All rights reserved,
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Office of Consumer .Affairs and Business Regulation
`'' 10 Park. Plaza - Suite 5170
Boston, Massachusetts 02116
Hone Improvement Contractor Registration
Registration: 126893
Type: Supplement Card
TIED AT HOME SERVICES, INC. Expiration: 8/3/2018
RICHARD TROIA
24.55 PACES FERRY ROAD, HSC C-11
ATLANTA, GA 30339
Update Address and return card. Marr reason for change.
i address 7 Renewal 7 Employment Lost Card
SCA 1 21 G
Office of Consumer Affairs& Business Regulation License or registration valid for individual use only
' r= HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
i' 0 ice of Consumer Affairs and easiness Regulation
Registration: 126893 Type10 Paris Plaza
- Suite 5170
Expiration: 8/3/2018 Supplement Card
Boston, rVlA 02116 .
THD AT HOME SERVICES; INC.
THE HOME DEPOT AT HOME SERVICES
RICHARD TROIA
2455 PACES FERRY ROAD, HSC
�Tt4NTA, GA 30339 Undersecretary valid without s*- ature
s CSSL-099699
ROBERT POCZOBUT ra
172 WHALERS LAVE � �y..�,•
SALEM MA 01970
02/08/2018