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Home My WebLink AboutBuilding Permit #121-2016 - 148 MAIN STREET 7/29/2015 BUILDING PERMIT NORTFj q gtti"EO 6 N TOWN OF NORTH ANDOVER 3 - o APPLICATION FOR PLAN EXAMINATION # h Permit No#: y Date Received A-ggococ.. .c Py 7� R.\TEO SSgCHu`�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 4 /Y& * /- 9�3? Print PROPERTY OWNER z'9 �a C4V-1Nq Prirtr 100 Year Structure yes no MAP Djo PARCEL:tm ZONING DISTRICT: Historic District yes no Machine Shop Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,Y,oRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��.�b/Q �� - C•� ��v Fla cUs^ �t/'o ,S�ru c.0'�K�2� ,� Identification- lease T pe or Print Clearly q OWNER: Name: e► v)� /A/ Phone: Address: Contractor Name: �Jya t�wP / Phone: 6/ 7 Email: Address: Yo lr--of'b P S 0 �� -Exp. Supervisor's Construction License: Date: h Home Improvement License: �� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7��3• FEE: $_ Check No.: VI b`a, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund X0 'MrV--- �l 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 a (septic tank, etc. ❑ permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes s Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Siqnature& Date Driveway Permit DPW Town Engineer: Signature: ,FIRE DEPA _ - Located 384 Osgood Street r __ RTMEN�T TempDumpster ontsite. eyes _ ono a i 1,Locatedlat'ti1241WinrStreet i Fi`re�Departirierit�;,sg:nature/date, _ COMMENTS, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No 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.Building 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 4 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses � Copy of Contract ;6 Floor Plan Or Proposed Interior Work 4. 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 ;rP 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) ;6 Building Permit Application 4 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit :aE 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 4, Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. 7i 5 ' Date �7_qlj • • TOWN OF NORTH ANDOVER � S��TLED 1�-qa • • Certificate of Occupancy $� Building/Frame Permit Fee w. $ y� ••' Foundation Permit Fee $ ,� Other Permit Fee $ TOTAL $ Check#AU3 7, Tt i Building Inspector NORTH Town of It E ..", Andover 0 C h ver, Mass, CO[NIGHtwic g00ATEO I'Pa��S S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......... ...... ................................................................ BUILDING INSPECTOR has permission to erect „ X ��,� �-VA.e,4 Foundation .......................... buildings on ........... ... ....�.�....��..�.�?l... Rough tobe occupied as ..... I�.!L ........ ... .^! .!^. . 1........................................................................ 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 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. etleWCll MA Home Improvement Contractor. bnderSenw Renewal by Andersen Corporation License#170810(Expires 12/23/2015) 'A Federal Tax ID#41-1918413: 30 Forbes Rd. Northborough,MA 01532 i (508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT -Bu er(s)Name Date: ELIZABETH EWING - MAY 18, 2015 'Buyer(s)Street Address City State Zip Code 149 MAIN ST. #C 237 NORTH ANDOVER MA 01845 'Email Address Home Telephone Number Work/Cell Telephone Number 978-989-9979 508-517-3825 Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor'),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 7,433 Amount Financed$ 7,433 Est.Start Date Method of Payment Deposit Received(33%)$ 0.00 Deposit at signing$ 3,716.50 Check/Cash 8-10 weeks Balance Start of Job(33%)$ 0.00 Check# Balance on SubstantialAt Substantial Est,Install Time Credit Card Completion of Job(33%)$ 0.00 completion$ 3,716.50 1-2 days If credit card is selected,please — No final payment shall be demanded until all parties are satisfied see Credit Card Payment form 'Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings ;changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,written consent iof both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has :received a completed,signed and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was. `orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation uye s t Buyer(s) By: nil Signature of Consultant Signature Signature x BRUCE PECK ELIZABETH EWING Printed Name of Consultant Printed Name Printed Name YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OTICE OF CANCELLATION FORMS FOR AN EXP THIS EXPLANATION F O O IS RIGHT. --------------------------------------------------------- I NOTICE OF CANCELLATION NOTICE OF CANCELLATION I i I I Date of Transaction 5/18/1.5 . You may cancel this I Date of Transaction ;,/IH/I5 .You may cancel this ;transaction,without any penalty or obligation,within three business days from the I transaction,without any penalty or obligation,within three business days from the above date.IF you cancel,any property traded in,any payments made by you under I above date.If you cancel,any property traded in,any payments made by you under ,the Contract of Sale,and any negotiable instrument executed by you will be I the Contract of Sale,and any negotiable instrument executed by you willbe ;returned within 10 days following receipt by the Contractor("Seller") of your I returned within 10 days following receipt by the Contractor("Seller") of your :cancellation notice,and any security interest arising out of the transaction will be I cancellation notice,and any security interest arising out of the transaction will be :canceled. If you cancel,you must make available to the Seller at your residence,in 1 canceled. If you cancel,you must make available to the Seller at your residence,in 'substantially as good condition as when received,any goods delivered to you under I substantially as good condition as when received,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of the I this Contract or Sale;or you may,if you wish,comply with the instructions of the `Seller regarding the return shipment of the goods at the Seller's expense and risk. I Seiler regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up If you do make the goods available to the Seller and the Seller does not pick them up .within 20 days of the date of your Notice of Cancellation,you may retain or dispose 1 within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available 1 of the goods without any further obligation. If you fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and Fail to do so,then I to the Seller,or if you agree to return the goods to the Seller and fail to do so,then !you remain liable for performance of an obligations under the Contract. To cancel I you remain liable for performance of all obligations under the Contract. To cancel Able transaction,mail or deliver a signed and dated copy of this cancellation notice I this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to Contractor:Renewal by Andersen,1 or any other written notice,or send a telegram to Contractor: Renewal by Andersen, i30 Forbes Rd. Northborough,MA 01532. 1 30 Forbes Rd.Northborough,MA 01532. I HEREBY CANCEL THIS TRANSACTION. i HEREBY CANCEL THIS TRANSACTION. I Buyer's Signature Print Name Date i Buyer's Signature Print Name Date . ......... .. .... ._ .... ........ A[ d VY Renewal by Andersen Corporation MA Home Improvement Contractor hY/�i1C�eirse. , ' 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015) wtxoow aenucetuext A;...,_,,,;,1., (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Window Specification Sheet ',,13u er(s)Name Date of Agreement ELIZABETH EWING MON, MAY 18, 2015 ;The buyer(s)listed above herebyjointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of which :the Specification Sheet is part. WINDOW&DOOR DETAILS App. App. App. Exterior/Interior Color Hardware Hardware LowE4/ Grille Grille Glass RRoom # width height U.I. Window/Door Style Detail Casin s Ext-Int Color style Screens Smartsun Grilles Sash 1/3 Sash 2 Lifts Options 103 29 46 75 DB s raila ual insert slo ed sill Ext.Wra H/W White Standard FFG martSu INTW 3/2 3/2 Yes 104 29 46 75 DB s rail a ual insert slo ed sill Ext.Wra H/W White Standard FFG mariSu INTW 3/2 3/2 Yes 105 29 46 75 DB s rail a ual insert slo ed sill Ext.Wra H/W White Standard FFG martsu INTW 3/2 3/2 Yes 106 29 46 75 DS sq rail equal insert sloped sill Ext.Wrap H/W White Standard FFG 3martSur INTW 3/2 3/2 Yes Total 4 BAY,BOW&BUILD OUT DETAILS Approx Style Detail/ width/ Approx. Number Frame Window End Center LowE/ Roof/ Hardware Room Count St le Flankers 'h Casin s An le Lites Interior ExVlnt Color Grilles sashes sashes Screens Smartsun Soffit Color SPECIALTY WINDOW DETAILS Full/ i Approx. LowE/ Specialty BAY/BOW ADDITIONAL WORK NOTES Room Count Style Insert i U.I. SmartSun Grilles Grille Style Ext/lot Color Customer is—'re that with ba elbow windows under 72 inches there will I si nifiemn gL ss lose. ADDITIONAL WORK DETAILS: I No Contractor will wrap exterior casings with coil stock color of Owner is aware that Contractor does not do any painting/staining or removal/installation of alarm system or window treatments/hardware.It is the responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to whether alarms or window 2 treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,the amount will be dependent on the type of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.Customer is aware and understands any and all unseen rot is not included in this contract.Should any rot be found there will be an additional charge for time and materials unless so stated in this contract. 3 Yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.Removal and disposal of all job related debris, windows,doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued. 4 Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the permit(s)is included in the total contract price. Yes All discounts have been applied to this agreement. 6 ✓ lis No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance forri It is agreed and undersuwd by and between the panics that(tis Specification Shcct,along with the CUSTOM IVINMO\V AND DOOR REMODELING AGREFIVIE N',constitutes the entire understanding bet,vecn the panics,and there arr uo verhal understandings ehanong or modifying any of the terms. 'I his Specification Sheet may not be changed or its frons modified or varied in :any way unless such changes arc in writing and si,picil by both the Buyeris)and Contractor. Buycr(s)hereby acknowledge that Buycr(s)has read this Specification Sheet. Renewal by Andersen Corporation Btty r(s) r Bnver(s) _3-iicc Pccc, .._..S—i Signature of Consultant Signature Signature BRUCE PECK ELIZABETH EWING Print Name of Consultant Print Name Print Name Renewal' b e ......... - CoNeam WINDOW, ALPLACEMENT w4ivVot.&rd4wt4 OWN 04,oorvokkur � - f''.'. 3r 's.�+ + •.txjrz,.t. %t ,w ;;r� y.�r ; "d? NvrfkAft4(vw, MA 03-845 Sites cf .jam Rlul : .. AWAxabue,NA,01 fj Awme(500 RISE FDA(:08)94i7UU i : .� a Renew r� �s•x�.. �,` b� .�. S 1dOiEfsec En wtNDoW• REPLACEMENT anMdetaan(>mmoy„ ` ->•�t : WoodArinyiComposite IF Dual Argon Low E4 SrnartSun w:gC:sxrr Double Hung 100-00473518-010 -ERERGY PERFORMANCE RATIKGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient v ABBI °IQNAL PERFORMANCE hATINGS Visible Transmittance % U � Manuheterar stipulates that thaw.1j"contain to app6zaak NFNC protad...for determining estate product performance.NFNC ratinget s ora determed for a&ad set of anVironmantal eondki re and a apocXr.product arta. NFNC does not recommend any product and does not tvamm the aukabby 01 any product for any apec6a use. C',manufactarer's koratura for other product pertormana nlormalion. rvWWWICAlg Tbia product moats Groan '• Satre Govk nmontal l standards gewmiog anergy 1.L°=yw� `'' �.,,.1,.•..+,i �s. racy.Mavy matat it �; ��Ll•�` '•`tM frame and eash 5�.!L7'•�'7, ?'i'i �-maters c and it?"•::r}z• l packaging, F r�4/F�.i 44 consumer educational Sf<¢ iF . qtr hi Wit;:;j`:`:•�f}til( 41 DESIGN PRESSURE(PSF) � MtmiTa°e�iamcL°amn p www.w�muom ' t t - - RbA DB Sloped Sill DH IH Tlstsi blWS-02aANdAA40M�R:SttillASrAMUUS h+lvvstlfacarsr at Les oonfurmartoa at tlBa imhl9 aNrgvos. gotta or oxceads M.E.C.,C.E.C,i I.E.C.C.Ak IntAndion requirements WOMA Naitark Cadi"lion Program. The Commonwealth of Massachusetts Department of lndushW Accidents Office of Investigations kv 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mas gov1d1a Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information , Please Print Leebly Name (Business/Organin6on/Individual): RENEWAL BY ANDERSEN Address:30 FORBES ROAD City/State/Zip:NORTHBORO, MA 01532 Phone#:508-351-2200 Are you an employer?Check the appropriate box: Type of project{required) : ].Q I am a employer with 30 4. ❑ I am a general contractor and I employees(full and/or part-time). 6 have hired the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 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.: q E]Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.[]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152, §1(4),and we have no employees. [No workers' 13•❑Other comp.insurance required.] ;Any applicant that checks box ill must also fill out the section below showing their workers'compensation policy information. homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such, f tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have I employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy#or Self-ins. Lic.#:MWC 30293800 Expiration Date: 10/01/15 Job Site Address: 149 Main ST. #C 237 City/State/Zip:North Andover, MA 01845 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 herebyy and the pains and penalties of perjury that the information provided above and cow Dat —� 0 1-2200 OjWuse 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 S.Plumbing Inspector 6.Other Contact Person: Phone#• ANDECOR-01 YADAVYO DATE CERTIFICATE OF LIABILITY INSURANCE1011120 4 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(les)must be endorsed. If SUBROGATION 15 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). PRaoucEa NAME CONTACT cerdflcates@wlflls.com Willis of Minnesota,Inc. clo 26 Century Blvd " S Ed: 87�946_7378 a.(888)467-2378 P.O.Box 305191 EA�SS: Nashville,TN 37230-5191 IN8UR S AFFORDINti COVERAGE NAIL k INSURER A:Old Republic Insurance Company 24147 INSURED INSURER 0: Renewal by Andersen Corporation INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01632 INSURERa: 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 VIAiICH 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 1ADDLI ICY EXP TYPE OF INSURANCE POLICY NUMBER IaM LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1,000,0001 DAMAGE TO RENT CLAIMS-MADE 0 OCCUR ZY302940 10/01/2014 10/0112015 PREMISES Ea occurrence 3 500,004 MED EXP(Any one person) 3 10,00 PERSONAL&ADV INJURY 3 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 X POLICY❑JEC�T F-1 LOC PRODUCTS-COMPIOPAGG $ 4,000,00 OTHER: $ AUTOMOBILE LIABILITY a arslde $ 5,000,00 A X ANY AUTO MWTS302576 10101/2014 10/0112015 BODILY INJURY(Per parson) $ ALL OVWED SCHEDULED BODILY INJURY(Per acCWerd) $ AUTOS AUTOS HIREDAUTOS AAUTTOS 0AMAGE 3 3 UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION S WORKERS COMPENSATION X STATUTE ER IE AND EMPLOYERS'LUUMAY A ANY PROPRIETORIPARTNERXECUTIVE YIN 177 10/0112014 1010112015 E.L.EACH ACCIDENT Is 1.000,00 OFFICSIUMEMBEREXCLUDED? N� NIA (Mveaid�do7inNH) E.L.DISEASE-EAEMPLOYE $ 11000,00 yDESC1rPrl%OFFOOPERAIIONS below E.L.DISEASE-POLICY OMIT 1$ 1100010 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addklonal Rsenrb Sabdule,may be athched IT mom space In mqulred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD f 4 �1 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supeni%or r T` License:CS-MI25 4. JAIMIL L MORM-` 86GARDINSRST. LYNN MA 01905 - �4`�� / Expiration Commissioner 10/08018 ` . � c-�1e�ommcoxw.eu/DEo��!1�aaoacsluvea3 MENNE"n ffice of Consismer Affairs&BIW13eea 8e9nlation IMPROVEMENT CONTRACTOR # Registration: 170910 Type: Expiration. 12/2312015 Supplement r i RENEWAL BY ANDERSON-COR' PORATIOM V- JAIME MORIN 104 OTIS STREET k NORTHBOROUGH,MA 01532 Underseeretary , .1