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HomeMy WebLinkAboutBuilding Permit #622-11 - 1459 TURNPIKE STREET 3/18/2011 TOWN OF NORTH ,ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ZZ — Date Received Date Issued: IMPORTANT:Applicant must mm lete all items on this page LOCATION 7 /g&rfr S� Print PROPERTY OWNER ify&P" 15Le� - Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building IrOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ARepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Floc plain ® Wetlands Wa ershedDisict So KIN r ®,Waf_er/Sewer ` '- DESCRIPTION&RZO O BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Xey11�7 Phone: Y,70 Address: y S�� �✓�'� � CONTRACTOR Name: �Co ���/«/� Phone: 7/R g!/A Address: ! /�� oma , ���'y�/ "Z"- Supervisor's -Supervisor's Construction License: Exp. Date: 3� Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ZO®O FEE: $ l , A74 Check No.: 1 --)t- ( r�, Receipt No.: � 10 NOTE: Persons contracting withwnve stered contractors do not have access to the guaranty f d >4 aM.Y Signature_of Agent/Owner / Signature_of:contract. _. _- --.�- .1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ "Well ❑ Tobacco e Tob o Sal s 11 Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ' DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS •L Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes PlanningBoard Acision: C , Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - TemPDs e �o Y t r 'te es no ; ump n Located at 124 Main Street x Fire Department signature/date �S-I COMMENTS . �_ Dimension Number of Stories:.Total square feet of floor area, based on Exterior dimensions. q l Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use �I I ® Notified for pickup - Date I' �J Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i I Roofing, Siding, Interior Rehabilitation Permits Building Permit Application a" Workers Comp Affidavit ZPhoto Copy Of H.I.C. And/Or C.S.L. Licenses 2"'Copy of Contract ❑ Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products/NOTE. a All dumpster permits require sign off from Fire Department p t p l rio r 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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic y Ic CalculationsIf Applicable) ( pp able) ❑ Muss check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit r 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 ❑ Engineering Affidavits for Engineered products MOTE: 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 t1hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording rriust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location `l A„ )` No. 2- Date 1 *ORT1y TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee $ swCHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23971 Building Inspector ORTH i Town of And h AK o '� dover, Mass., COCMICKEWICK y1. �d ADRATED 7S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System - i • BUILDING INSPECTOR- V%40 NSPECTOR- i THISCERTIFIES THAT......... . ..........h�........DA.... .. ...................................................................................... Foundation has permission to erect........................................ buildings on �... Rough .I..... .. ...........'T +p� .... to be occupied as.........oe....� 4 Chimney k�.... .. .............C...1�►�' ............................................. provided that the person accepting this permit shall in every respect con rm to the terms of the application on file in Final 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 e Final .. PERMIT EXPIRES IN 6NTHS ELECTRICAL INSPECTOR r I b UNLESS CONSTRUC N S Rough ............................................................74"� .... Service BUILDN Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the- Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner. Street No. SEE REVERSE SIDE Smoke Det. 03/18/2011_07:,51 9786570201 TL SOUTHMAYD INS PAGE 01/01 RightFaX N3-2 3/18/2011 7:07:11 AM PAGE 21002 Fax 8ervtr ACORD. CERTIFICATE OF LIABILITY INSURANCE 03/18/2011 1141S CERTIFICATE is ISSUED AS A MATTER OF INFORMA710N ONLY ANb CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER,THIS ND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AME CHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE IssUINA INSURER(3),ALrTHORt2ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT!if.the oertif ants holdor Is vn AOD(nONAL INSURED,the Poli y(ieA)must be endaroed. H SUBROGATION IS WAIVED,Aubject to the terms and Bend@ions of the policy,certain policies rmy requiro and enderiemont. A Atetement on this certificate Boos not confer rights to the certificate holder In Lieu of oueh endorsemong9). CONTACT PRODUCER NAME: PHONE FAX (A/O,No,Ext): FAX TL SOUT14MAYD INS AGCY LL 668 MAN DR STREET#9 ADL ADDRESS: PRODUCER WILMINIMON.MA 01887 CUSTOMER IO>r INSURERS)AFFORDING COVER AGE NAICfi 76TRF7 INSURER A: TRAVGT.TZiS T;:[REC7C ASSIGNMENT INSURED INSURER B: MCELLO SCOTT DOA FU14TCE-LLO MASONRY INSURER C: r(Ja INSURER D: ONE WIT-LARD CIRME INSURER E: ANDOVER MA 01.810 INSURER F: NUMBER: REVISION NUMBER: CERTIFICATE NU OR THE POLICY PERIOD INDICATED. COVERAGES FD ABO F TH1918 TO GERIt1yTNAT THE POLICIES OFIMBURANCE CONDITION OF BELOW HAVE BEEN R OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE M9UED NOTWRKBTANDINO ANY REQUIREMENT,TERM OR CONDITIONED ES CONTRACTOR 0TH OR MAY PERTAIN.THE INSURANCE AFFORDED BYTHE POLICEe DESCRIBED HEREIN 18 SUB rEOT TO nLLTHETGRMB,EXCLOAIONS AND CONDITIONS OF SUCH POLICIES. UMrr9 SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. IN-SR AODLSUe3 POLICY NUMBER POLICY MTtDMVYWj f POLICY rA �%Y�l:- UMR8 . TYPE OFINSURANCE {NBRWYO LTR EACH OCCURRENCE S GENERAL LIABILITY COMMERCIAL OENERALLIABILITY DAMAGE TO RENTED $ CLAUS MADE OCCUR. PREMISES(Ea occurrenca) MED EXP(Arty Ona Poreon) S PERSONAL A$ADV INJURY $ OEM AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE S POLICY PROJECT LOC PRODUCTS-COMP/OP AGO S COMBINED SINGLE R AUTOMOBILE LIABILITY LIMIT(En accl0nl) ANY AUTO BODILY INJURY S ALL OWNED AUTOS (Por pvrmn) SCHEDULE AUTOS BODILY INJURY HIRED AUTOS (Par accidord) NON OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIA9 CLAIMS-MADE AGGREGATE $R DEDUCTIBLE S RETENTION $ WC9TATtITORYLIMITS ' OTHER WORKER'S COMPENSATION AND EMPLOYER'S LIABIUTY YIN UB-0839M235-10 0912BJ2010 09n812011 E. DISEASE GEAEEEMPLOYEE $ 100 000. ANY PROPERITOWPARTNFR/EXECVTIVF, Y OFFICER/MEMBER FxcwDEDT E.L.DISEASE-POLICY LIMIT $ 500,000 (wridcrory,In r.+!+) It y?a,durvIbe!mdnr DESCRIPTION OF OPERATIONS bolow DESCRIPTION OF OPERATIONS/LOCA-nONSNEHICLESIRESTRICTIONSISPECIAL ITEMS 7TM REPT ACFS ANY PRIOR(;VK IIF CAV,IssuM TO TM CERTIFICATE NOT DER AFFECtaTO WORTCERS COMP COVERAGE_ THE WORI2RS'COMPENSA'ITGNPOLiCYDOM NOT PROVMECOVERAGE FOR RW.CPLLO SCOTT. CANCELLATION CERTIFICATE HOLDER TOWN T N ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE BUILDING DEPT WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE NANDOVERMA 01845 Charles 1 Clark ACORD (2008/09) 1986-2009 ACORD CORPORATION. All rlght8 re9erved- i i hightrax 1VL-'L J/18/-L011 7 : 07 : 11 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 03/18/2011 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX TL SOUTHMAYD INS AGCY LL (A/C,No,Ext): FAX (A/C,No): 668 MAIN STREET#9 E-MAIL ADDRESS: PRODUCER WILMINGTON,MA 01887 CUSTOMER ID#: 76JRH INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS DIRECT ASSIGNDIENT INSURER B: FUMICELLO SCOTT DBA FUMICELLO MASONRY INSURER C: INSURER D: ONE WILLARD CIRCLE INSURER E: ANDOVER,MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE 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 ALLTHETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF DATE POLICY EXP DATE TYPE OF INSURANCE POLICY NUMBER (MNADD\YYYY) (MMADD\YYYY) LIMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATUTORY LIMITS OTHER WORKER'S COMPENSATION AND EMPLOYERS LIABILITY Y/N UB-0339M235-10 09/28/2010 09/28/2011 E.L.EACH ACCIDENT $ 100,000 ANY PROPERITOR/PARTNER/EXECUTIVE Y E.L.DISEASE-EA EMPLOYEE $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE W ORKERS'CONIPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR FUNRCELLO SCOTT. CERTIFICATE HOLDER CANCELLATION TOWN OF N ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE BUILDING DEPT WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE N ANDOVER,MA 01845 Charles 7 Clark ACORD 25(2009/09) 1988-2009 ACORD CORPORATION. All rights reserved. FuM' ICELLO MASONRY Stonework,) Landscapes & Masonry 1 Willard Circle,Andover, MA 01810 781-718-2188 Homeowner Information Contractor Information Name Company Name / // �el/l/I !� c//yli GC d Street Address(do not use a Post Office Bos address) Contractor/Salesperson/Owner Name /fCi`tyrrown /St�ate/f Zip Code Business Address(must include a street address) Daytime Phone Evening Phone Cityrrown State Zip Code 978-- Mailing 78_Mailing Address(It difrerem from above) Business Phone Federal Employer 11)or S.S.Number Itmne Impm�rncrM Comma.,Rett.N—t- Fvim—Mtr Iw .,.6r.2b.9 roma b- h.pn+e•w.1 cawtr.rW hunt ■'tact Z!",.tie..w.brr /�5 — — ®_ The Contractor agrees to do the following work for the Homeowner: C (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of -3f& Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Prise and Payment Schedule /fj The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum o�� Payments will be made according to the following schedule: S upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) S SOS by _/_/_ or upon completion of �� 1::1 / 2 S_ by or upon completion of S, upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) the following material/equipment must be spatial S to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(')Including all finance charges(••)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Extarm Warranty Ia as rtaoress warraan bellm arevio'ed by the contractor? u No❑Yes(aa terisa tithe ararraaht tarot be•rc•ebed to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third ptnrty/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor ander this aareenrent Contract Acceptance-Upon signing,this document becomes a binding contract reader law. Unless otherwise noted within this doctmuent,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully,before signing this contract. • Don4 be pressured into signing the contract.Take time to read and fully understand it Ask questions if something is unclear. • Make sure the contractor has a valid Horne l=nn ernent Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you,can confirm coverage,or ask to see a copy of a"proof of insurance"document • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You miry cancel this agreement if it has been signed at a place other than the contracto>'s normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreemem See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPAC S!!! TWO, .at copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be ke contractor. Ho s ature Contractor' ignantre Dae Date Date: f � Fumicello Masonry Invoice/Proposal Scott Fumicello ����� ,; 7fl'7 1 Willard Circle Andover, MA 01810 781-718-2188 781-649-0755 - � 1 7<1 O G f G t NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: ✓ie d is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section l OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant X Date l�e/t' /IAS 7o }55k1e- 7l� ��,5 6?177;7 ACO® DATE(MM/DDIYYYY) COP CERTIFICATE OF LIABILITY INSURANCE . F 3/17/11 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(tes) 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: T L Southmayd Insurance Agency PHONE 978 657-0263 1 FAX N : (978) 657-0201 668 Main St, Suite 9 ADDRESS: louise@tlsins.com Wilmington, MA 01887 PRODUCER 2428 INSURE S AFFORDING COVERAGE NAIC# INSURED INSURERA:St Paul Travelers WC-AR Scott Fumicello INSURER B: dba Fumicello Masonry INSURER C: 1 Willard Circle INSURER D: Andover, MA 01810 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: T141S iS TO CERTIFY TI AT 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP UMTS LTR POLICY NUMBER M/DDIY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAM-MADE F-1 OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATELMITAPPUESPER PRODUCTS-COMP/OPAGG $ POLICY PE C RO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (E a accide rt) ANYAUTO BODILY INJURY(Per person) $ ALL O WNE D AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION 7PNB-0339M23-5-10 9/28/10 9/28/11 WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERlE�CX1TNE YIN, ORIG TO FOLLOW E.L.EACH ACCIDENT $ 1,000,000 OFFICERNEMBER EXCLUDED? NIA (Mandatory in NH) FROM THE STATE E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I. R000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept AUTHORIZED REPRESENTATIVE Louise Southma d Manager ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Boardof Builtlin �2e ulations ant! Standards Construction Supervisor License License: CS 77991 SCOTT W FUMICELLO ` 1 WILLARD CIRCLE ANDOVER, MA 01810 ~° --�-- -�! Expiration: 8/30/2012 Commissioner Tr#: 605.1