HomeMy WebLinkAboutBuilding Permit #780-16 - 1492 GREAT POND ROAD 1/5/2016 r ot NORTH
v 1 I BUILDING PERMIT r 6' r .'=
TOWN OF NORTH ANDOVER 9
G� APPLICATION FOR PLAN EXAMINATION
Permit NO: O Date Received
Date Issued:
IMPO TANT:Applicant must complete all items on this page
LOCATION l4 9�, Grec V Prhr-) Rood
i
Print
PROPERTY OWNER `�c:,e- �- �4.tm Ma'''` ��`' 1
Print
MAP NO: PARCEL: SO ZONING DISTRICT: Historic District yes no f
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building Xbne family
❑Addition ❑Two or more family n Industrial
KAlteration No. of units: ❑ Commercial
Repair, replacement 1 i Assessory Bldg i I Others:
❑ Demolition ❑ Other
i i Septic i Well i i Floodplain I i Wetlands i i Watershed District
❑Water/Sewer
re.inade-1 incl,,J;"c hec., CezS,rcASr f loco %�) , edec�V"eei
t�OC�o.Fcs 0IvIM�,'�c ��°Oty �yt�cl(. -
Identification Please Type or Print Clearly)
C:n OWNER: Name: -cse tb)r\ Mare- rva'-, I Phone: S09' '7"7'. -7A67
Address:
CONTRACTOR Name: "5����ha� G S,.)r,��� Phone: EOE-
Address: Prov,dch ce Alk,'\s c-, ry u o 3 e l i
Supervisor's Construction License: Exp. Date:
C,S- 67GG4 3 Q�a
Home Improvement License: 159 Ll L) y Exp. Date:
i
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: $ 1 _ 990 J"_ FEE: $ "-`�'j -7c Oa
Check No.: Receipt No.: '- f so .z
NOTE: Persons con ratting with unregistered contractors do not have access to he guaranty fund
C--Signature of Agent/Owner .�,� ignature of contractor
�,
J `
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
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
om Fire Department prior to issuance of Bldg Permit
OTE: All dumpster permits require sign off fr
New Construction (Single and Two Family)
Building Permit Application
4 Certified Proposed Plot Plan
4. Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
,4 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
CITE: 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
-`1
7
I
Dimension
t
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
I
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANCER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
i
i
1
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
C-
- — -- -- — — — -- - - — - r
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. ❑ Permanent Dwnpster on Site ❑
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
J
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
Reviewed on
Signature
COMMENTS
! Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
t `
Planning Board Decision: Comments
Conservation Decision: Comments
Wafter & Sewer Connectionisignature& Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street a
.FIREDEPARaTiMENiT TimpDumpsterr;onsite kyyes;
I
}45cdtedAt,12,M-MaintStrbet,.
'COMMENTS-
Location
No. � V � Date /
TOWN OF NORTH ANDOVER
LED •
ee Certificate of Occupancy $
Building/Frame Permit Fee $ 0
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
r�t
Check# s J
`� Li Building Inspector
N -r
own of ndover
O 0%
No.
". h ` ver, Mass
o
,!- coc"ICMIWK.
S U BOARD OF HEALTH
PER 11 T LD Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT ......... E.../, ,4h1. .........................................................................................
� Foundation
has permission to erect .......................... buildings on : .. .. ! ...... ............•••
Rough
to be occupied as ..........r!'f� t ���... . .
..
............................................................ Chimney
.
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
j 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
711 Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS - ELECTRICALINSPECT-R
UNLESS CONSTRUCTIO#STARTSRough
I _ �"- Service
...... ... ...... .. . ....................
...:..
BUILDING. . . INSPECTOR.. Final
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.
i
Smoke Det.
i
i
Management,JOSCON
BUILDING&REMODELING
CONTRACTOR
MASSACHUSETTS HOME IMPROVEMENTS CONTRACT
This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to
protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer
Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and
Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name
Mr.&Mrs.Nahil Company Name
Joscon Management,Inc
Street Address(do not use a Post Office Box address) Contractor/Owner Name
1492 Great Pond Road Jonathan O'Sullivan
CityRown State Zip Code Business Address(must include a street address)
North Andover,MA 01845 185 Atlantic Avenue
Daytime Phone Evening Phone 508-776-7269 City/Town State Zip Code
nanapa@comcast.net
Salisbury,MA 01952
Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number
603-489-1568 61-1403121
Home Improvement Contractor Reg.Number 159444
Expiration date 4-30-2016
The Contractor agrees to do the following work for the Homeowner:
Scope of Work
The following scope of work is to remodel the existing kitchen area per Jackson Kitchen Designs plan dated 10415.
• Building permits per the Town of N Andover,MA.
• Temporary protection and daily cleanup throughout the remodeled areas.
• Demolition work to include the following: Removal of the cabinets,countertops,appliances,flooring and walls for the new layout.Flooring removal
figured on bringing the existing flooring down to the sub floor. Disposal of all construction related debris.
• Wall adjustments to be made for the new layout.
• Install new'%drywall on all disturbed walls,door enclosure and misc.patch work as needed. Install 3/8"drywall over the existing ceiling throughout
the kitchen area. The existing ceiling will have holes from the existing lighting layout and cutting to access for the new recessed lights 1 wiring will
need to be done. Finish drywall off with a smooth finish.
• Installation of the homeowners purchased cabinets per Jackson Kitchen Designs plan dated 104-15. Includes all moldings and hardware.
• Install homeowner purchased appliances. Appliances to be brought into the house by the delivery company. Vent the hood to the exterior of the
house. Further exploratory work needed to determine the actual vent termination location. Currently figured on running the vent to the back
between the kitchen and bathroom windows.
• Prepare kitchen area for new hardwood flooring.
I
• Supply and install new 2-114°red oak flooring throughout the kitchen area. Flooring install will stop at the family room under the beam. Currently
figured on matching the dining room floor height. Once the existing kitchen flooring has been removed,we can determine the actual finished floor
height. Sand and finish the new hardwood flooring. Install a transition strip between the kitchen and family room flooring.
• Plumbing work throughout the kitchen area to include the removal of the existing kitchen sink and appliances. Rough in and finish the new sink,
faucet,dishwasher and ice maker. Temporary sink and faucet will be set up by using the existing sink Ifaucet. Plumbing venting upgrades 6
needed will be considered additional work.
• Electrical work has been figured on code upgrades throughout the kitchen area,re work existing electrical per the new layout,install 9(5°)recessed
lights. Install homeowners purchased surface mounted lights. The panel may need to be upgraded and further exploratory work needed. If we are
able to reuse some of the appliance power sources and they are to code,electrical pricing will be adjusted accordingly.
• Carpentry work to include baseboard moldings throughout the remodeled area as needed and new trim at the kitchen sink window. Trim the new
kitchen door.
• Painting by others.
• Install homeowners purchased cabinet hardware.
• Final post construction cleaning throughout the project area.
Total for the above scope of work including the Allowance amounts: $19 0
3y��so
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following
And will be secured by the contractor as the homeowner's agent:
Building permit schedule will 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 1416 Date when contractor will begin contracted work.
MGL chapter 142A.)
1-29-15 Date when contracted work will be substantially completed.
Final completion date will be determined once we get the granite install
date.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of:$19,755.00 (*)
Payments will be made according to the following schedule:
$5,926.50 30%Upon the signing of the contract and the start of the project
$5,926.50 30%Upon the of the start of kitchen demolition and start of carpentry items
$5,926.50 30%Upon the start of the kitchen cabinet install,
$1,975.50 10%upon substantial completion of the contract not including the shower glass door install. (Law forbids demanding full payment until contract
is completed to both party's satisfaction)
The following material/equipment must be special $0 to be paid for NIA
ordered before the contracted work begins in order to meet the completion schedule. (**)$0 to be paid for NIA)
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.
Express Warranty•Is an express warranty being provided by the contractor? oNo 0 Yes(all terns of the warranty must be attached to the contract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor
utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this
agreement.
Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,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.
Don't 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 Home Improvement Contractor Registration.The law requires most home improvement contractors and
f
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 may cancel this agreement it it has been signed at a place other than the contractor'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 agreement.See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Two identical copies of the contract must be gmpleted and signed.One copy should go to the homeowner.The other copy should be kept by the contractor.
o . ov
Homeo is Si na ure --- Contractor's Signature
�gz J// i5 1��3iffS
Date Date
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)9 they have a
dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has
with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to 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 Office of Consumer Affairs and Business Regulation
and the consumer shall be required to submit to such arbitration as pro ' ed In Massachusetts General Laws,chapter 142A.
Homeowner Si nature ontractoes Signature
9 9
NOTICE:The signatures of the parties above apply only to the agreement of the parties to aitemative dispute resolution initiated by the contractor.The
homeowner may initiate aitemative dispute resolution even where this section is not separately signed by the parties.
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not
be waived in any way,even by agreement.However,homeowners may be excluded from certain rights it the contractor they choose is not property registered as
prescribed by law.Homeowners who secure their own building permits are automatically excluded from all 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 be entitled to other
specific legal rights it the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided
by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other
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 rights.If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below).
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 all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed 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 copy of the contract,and the three day rescission period has
expired.
� I
r"
Accelerated Payments
A contractor may not demand payments in advance of the dates specified 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 that 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 parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or 9 you wish to obtain a
free copy of"A Massachusetts Consumer Guide to Home Improvement"contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the OCABR website at http:/4*w.mass.gov/ocabri
If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration
component of the Home Improvement Contractor Law,contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the HIC website at http:/Iwww.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:http://db.state.ma.us/homeimprovemenUlicenseelist.asp
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
508-652-4800,508-755-2548 or 413-7343114
The Commonwealth of Massachusetts
Department oflndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
° www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERAHI"PING AUTHORITY.
Anolicant Information Please Print Legibly
Name(Business/Organization(Individual): StySc-c~ MraY1uxgeTAer�-
Address: )1 YLO=C)
City/State/Zip: /� -l�.�S c� lv�( G 3` 1 Phone#:
Arryo employer?Check the appropriate boa:
Type of project(required):
1. employer with :?: employees(full and/or part-time).« 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in $_ ;! emodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10[:]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietorswith no employees.
12.0 Plumbing repairs or additions
5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs
These sub-contractors have employes and have workers'comp.insurance.t
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.] i
*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
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
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. AA {� `
Insurance Company Name: 1* t'r'y 1 eC� c•. �rC. I
Policy#or Self-ins.Lic.#: 9 `1 10 13 Expiration Date:
Job Site Address: R �Ye G ��}� 1 Gd City/State/Zip-
i
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cert' under thepains andpenalties ofperjury that the information provided above is true and correct
Si nature• Date:
Phone# Of - i S `✓'
Official use only. Do not write in this area,to be completed by city or town offtciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Jan.01.2012 12:00 AM Advantage Insurance T,Genc 978 794 4233 PAGE. 1j i
CERTIFICATE OF LIABILITY INSURANCE DATE(MMUDDNYYY)
111/09/2015
THIS CERTIFICATE IS ISSURD AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
JCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIF)CATIE OF INSURANCE "-DES NOT CONSTITUTE A CONTRACT 0E7%Vr_EN THE !$ UNG INS,URER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND TME CERTIFICATE HOLDER.
IMPORTANT: If e certificate holder is an ADDITIONAL INSURED. the pot cyties) must be endorsed. If SUBROGATION IS WAIVED, sublect to
the terms and conditions of the policy, certain policies may require an andoMamant. A btdternant on this certificate does not Confer rights to the
Certificate holder In lieu of such andorsement(s).
PRODUClII un
NaME:Ti" PAUL DEVIN
AY;V1�Ai'!'P►ti" INus. AG,"N-= INC... _..._...._
PLAM N979-68
NO,Ex* 1-1055 I(AC No�978-794-4$33
1$4 PL1Tft3T "VALLEY STREET' taon ------ _
NETHUM, MA 01844 RODRESa:
..... INSURER(eI AFPORDWC COVFRACE NAIL N
INNMRA:ARBELLA PROTECTION INS. CO.
INSURED .. .._.._._
JOSCON bfiUVAG :T iltC. INSURERS:
INSUAER C t
72 PROVZDSNCE HILLitOe'�D
_._--_-.._..--.._-_._..__...................._........... . . .............._..
INWRE_RD;
ATKINSON N H 03811 INSURERE!
INCURER N;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TCl CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW FWVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INNC,ATEQ. NOTNATHSTANDINC ANY REOUIREMENT, TERM OR C,ONOITION OF ANY CONYRACT OR r?tHER Dn(iIIMENT VYITH RF3PECT ?C} WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSR YV1(D POLICY NUMBERMwo LIMITS
( a+'Y'r+7 (MMND/YY1'YI
A flENERAL LIABk_riY I B50DD e1��gD 0$/30/201 0$/30/2016 EAGN QOGURRENCE f 1t0Q0,000
COMMERCIAL GENERAL LIAMLITY PREMI8Q8(Eo oMkranm) � 10 0,000
CCRIMB-MAGE pCC,.UR I MED EXP(Any ORe PBS)____ 6 5,000 —
PERSONAL B ADV INJURY 0 11000,000
GENERAL AGGREGATE s 2,000,600
OEN'LAOOREOATE LIMIT APPLIES PER: I PROD UCTS-COMPIOP AGG S 2,000,000
L...... PRO. ._...-I
POLICY J€CY Loa 5
AUTOMOBILE 4WEIPLITY t
ANY Atftts SOONLY INJURY(Pet Person) S
ALLOWNFD SCHEOULEO ( ... ............_...__.....-...__._. __—.._—___, ..
AUTOS AUTOS I BODILY INJURY(Per auitlo^rfi
NON-OWNED ---_.—__
HiREO AUTvS PROPERTY UAMME
AUTOS (Per dccldeM) 8
z
UMBRELLA OAR OCCUR EACHOCCURRENCE
S
EXCESS LIAB I ,..�...
..J.`~'Is•,"'o—""•�` AuvREGATi C
oEc RETENTION s �.
A. 1YORKE115COMPENSATION 91214X31013 1Q Q� 2
AND F,YPLOYERB'L!ADILITY YIN ! / 015,10/05/201 -
i.'Y LIYYfS x ER
!!Y PROPR!ET{+PIPA4TNFF.>x><EVltIVE
IOFFICERIMEMBER EXCLUOEDT IV I N/A E.L.EACH AGG:CENY T..—_ w 1,000,000
(MAnHok"In NMjr I L—.� I E..0.1SEA` EE-EA VAPLOYEE 3.000.000
If YEA deeeAt*uoder --
OESOPJPTION OF OPERATtO1:9 8dlx. E.L.DISUSE-POLICY LIMIT- 1,000' ()DO
I
I
1)6iCRPTIOri OF OPERATIONS/LOCATIONS 1 VEHICi.Ea(ANAUt ACORD ICI,Aftlij*Ai RAmkeko BChedule,N room opwo ie re9u(red)
BUILDING S REMODELING CONTRACTOR
AND AIvcL WiiciE ir'AFiili 1452G=AT FOi3>j Ofii, irORT`si ANTD-QVii:IA MA 01645 I
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER
i
BUILDING DEPARTMVIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATIDN- DATE THEREOF, NOTICE %MLL: BE DELIVERED IN
1600 OSCOOD.ETP.EET ACCORDANCE WITH THE POLICY PROVISIONS-
�i
_LD 3FfG 20, SLSiTr 2035
AUTHORIZED REPREB
ORTH ANDOMR, MA 01.845
196!7-2010 ACDRD ORPORATION. All rights reserved.
ACORD 23(2010105) The ACORD name and logo are registered marks of ACORD
��c�ruirxr=rirrcrilfl t�"Ifr.:ur�u.K'i�%. ,
=^ f% of Consumer Affairs&Business Regulation
i -= ME IMPROVEMENT CONTRACTOR-
istra"on: 159444 Type:
pirabon: 46012018 . Private Corporar"o+
a JOSCON MANAGEMENT INC.
JONATHAN USULLIVAN
72 PROVIDENCE HILL RD.
ATKINSON,NH 03811- Undeisecretary
Massachusetts-Department Of Public S-ate:y
Boars:of I20di¢*Fcauia€icr:s and S`af `da'
C<<irtiLYUt:tjjjn�iSr1Ci5'I4u,
License: C"7 W, x.
JONATHAN OSUJAWAN J�
185 Atistntic Ave 84
Salisbury MA 0199
axrira-tT_ci 1 _
�.�•��' 0812M16
Corrrnssioner