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HomeMy WebLinkAboutBuilding Permit #751-16 - 15 BRADSTREET ROAD 12/21/2015 BUILDING PERMIT tkoRYp! � +IZ �)U A.0 TOWN OF FORTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION ./ �0 � 10Hry41 Permit No#: / Date Received �Rp°R�reo �SSHCHUS�t Date Issued: KFPORTANT-Applicant must complete all items on this page - nt � •' ® t3. .#.w "was i ...'+ � .• �+��� � _..,P$r � � L. ^�,�`� �` _� •` � "��at �, x� �� ' uFe MAP PARCEL. ZONING©ISTRI T; _ ` I-Iisto�ic ®istnct ; es n ' y. _ ¢� � ` Machine Sho= Villa e es" I. i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other 3 ._ t5'`� k r _..s �+,? .` so wo ®Septic ®WellFloodplinIC VZ t r/Sewer _._�-�. DESCRIPTION OF WORK TO BE PERFORMED: V:2 Se4��✓mac T7 r�C rf^SJ(k Identification- Please Type or Print Clearly OWNER: Name:_T Phone: c)>F d of f � Address: W0701 ;t a T : u Contractor Name { Jlr; :� -n�cPboneX ii ,yo� ��w Him ail w. Syuperuisor's Construe ion'License; t�Gor Home Improvement License: ! ��__ _ _Exp. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED,COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: Check No.: �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund, Signature_of Agent/Owner _gnature ofjco.ntractor,. ' .f Location /L-> � em No. l0 Date rt a • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ t Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ Check# 9 .4 5 Building Inspector i Plans Submitted ❑ Plans Waived_❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools . ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectiofl/S.i�nafure&Date Driveway Permit 7DINV Town Engineer: Signature: Located 384 Osgood Street yFIRE DE PAR -MEfVT Temp Dumpster onsite }' � � � `4 � �J, xtr{*,ci c t4 lye`S e .s �'rt�._. 1nkmn steno}. x>€t '��'+iL'?�r' ' 7 °' +` " f` f�; 4 F�re� Main :•itF3� r �` {Department signature/date � � aT?i. f ar 4 i,�.,.,,2"`'�.:"7iE� - L �✓���'�(j � Y.• `t aYsrwa�{h�?�H'3c .t`' -x##-y�'7�,as-x ,y�gry n f a 'i 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 apse) i ® Notified for pickup Call Email I Date Time Contact Name Doe.Buifding Permit Revised 2014 Building Department The following is a list of the required forams 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 o 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 ®TE: 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) o -Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ATE: 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 Clerics 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 Doe:Building FermitRevised2014 , tko TH Town of No. _ _ h , ver, Mass, A- coc NIC Ntwice( 7,9 A°R�reo ►�Pp,��(5 S U BOARD OF HEALTH i IPERMIT T L D Food/Kitchen Septic System �.{�p��,�, BUILDING INSPECTOR THIS CERTIFIES THAT ......... ...... ... ... .. ...............�r.................................................................... . has permission to erect .......... buildings on .1�' &: sT� Foundation ................ ....... ............ ............................. Rough to be occupied as JAf .T+.:+FA ..... ... .✓. ............................................... 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 CONSTRUCTI -IMRough ----- 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. Federal[DO 064406626 RISE Engineering Nl contractor limon No 8186 AAA Contractor Reglshatlon No 120879 A division of Thlelseh Engineering CT Contractor Regan No 62M2D 60 Showmut,Canton,MA 02021 339-502S197 - FAX 339-5 U345 CONTRACT Page 1 PROGRAM tu>OMMarm oeOMWMuNSE �,, CMA-MS + nieeussoase FMVM cas Patrick Bateman (978)208-1582 09/27/2015 413289 00007 11101111 57M Guam STRUT0 15 Bradstreet Road �;Mal °O 15 Bradstreet Road N North Andover,MA 01 - W North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide laboro your home against wast K excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours. A reduction in cubic feet per minute(cf n)of air infiltration will occur,but the actual number of cf n is not guaraideed. At the completion of the weatheention work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-conhactor to ensure the safety of the indoor air quality. $680.00 AIIt SEALING ADDER: (2)working hours. $170.00 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class 1 Cellulose added to(864)square feet of floored attic space. $1,537.92 ATTIC FLAT:Provide labor and materials to ill a 10"layer of R-35 Class 1 Cellulose added to(196)square feet of open attic space. $288.12 SLOPES:Provide labor and materials to irustall a 10"layer of R-35 Class I Cellulose added to(128)square feet of slope area Wherever possible,baffles will be installed to the entire length of each bay to maintain ventilation space. $249.60 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Thermmr board and seal the door's edge with weatherstripping to restrict air leakage. $73.91 VENTILATION:Provide labor and materials to install(5)8"diameter roof vents)to increase ventilation in attic areas The vent can be supplied in(circle color)black,brown,gray or mill Snisb. $427.50 VENTILATION:Provide labor and materials to install ventilation chutes in(64)ratter bays to maintain air flow. $128.00 RISE Engineering will apply all applicable,eligible incentives to this contract You will only be bulled the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 1000/6 for the Air Sealing measures up to the frost$680 and an additioral$340 if savings are justified by the auditor. For the safety and health ofyour home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weathetuabon incentive is$3,110. $90.00 r Federal ID S 054056n RISE Engineering MA�ctrRono�ConaaRe N2Wa A division of Welseh Engineering CT Contractor Reglstratlon No M120 60 Shawmat,Canton,MA 02021 CONTRACT 339-SM197 FAX 339-602-6345 Page 2 PROGRAM Tl CWQRAerls wro MW CMA-HES C aM�C WE FORWD NAB Patrick Bateman (978)208-1582 09/27/2015 413289 00007 our 15 Bradstreet Road 15 Bradstreet Road --oERVME-cnY,V1A1E,ZW sum am.SUM zw North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,645.05 Program Incentive: $2,940.00 Customer Total: $705.05 WE AGREE HEREBY TO FURNWN SERVICES-COMPLETE IN ACCORDANCE WRH ABOVE SPECIFICATOM FOR THE SUM OF ***Seven Hundred Five&051100 Dollars $705.05 e a0.WVCEAF7Htpi0AMOA ALR USTOU t OtI FOWA ,pWMEt '0F 1%VML6EE WAR iORRf�MTONA DO NOT WN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Mkhad Tmdwu(Sep 27,2D15) aQTi�ie1! aTpi�,a., Signature:,,Pa�batman(SOP 2e,2015) Email: bateman.pj@gmaii.com NOTA:TWBCDeIIRACrWAY BEMLfImRAIAMaYOetFNOTNIO<gR®YMrfQN _...__..._._pp..-._- pig ppb .30 DAYS. SAAMCCMMUSAND MU ACCs IL WORK AS SPOWM PAWIUM WILL UMM AS 01ntB8DASOVa i OWNER AUTHORIZATION FORM Patrick Bateman I, (Owner's Name) ' owner of the property located at 15 Bradstreet Road, North Andover, MA 01845 (Property Address) 15 Bradstreet Road, North Andover, NA 01845 (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. o,sa 'pahkk W..(SP 28.2Q,6I Owner's Signature I 9/28/2015 Date x Tile Coni/1ioni e(II$/1 of lJJas5(Ic1111Set1S Departmietrt of Ilrtlalstrial Accidents Office of litvestig,atio115 600 lWasluli ton Street Boston,11,1A 02111 ti1)�lp.PlIfiSS.g ov1dla Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbers Apnlicafit laformation Plea§e Print 9.r�'�ibh Name (Business!Oreanization/individual): O leyr- t �� ��7–Y'a 7 m—e — Address: Cit-.%-lState/Zip:_A-A J00-ff- r4 J ,2182 Phone#:—Q7 6 Are You an employer?Check the appropriate box: Type of project(required): 1.99 am a einplover with `I- ❑ I am a`eneral contractor and I entplopees UWI and/or part-time). have hired the sub-contractors b ❑bets construction ?_❑ I am a sole proprietor or partner- Listed on the attached sheet- 7. ❑ Remodeling ship and have no employees These subcontractors have S. ❑ Demolition %=orking for me in an,,,capaciq-. employees and bare workems [No%vorkers-comp.insurance comp.insurance' 9- ❑Building addition required.] �- ❑ A`e are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeoivner doing all work- officers have exercised their 11.❑ Plumbing repairs or 2dditions myself_[-\o workers'comp. right of exemption per MGL Q_❑ Roof repairs insurance required.]` c. 152-15,1(4).and tve have no empiovees.[\o workers' comp.insurance required.] °:Un applicant that checks box=i must also hill out the;ection below showins their%vorkers-compensation polio-information. r 1 tar eou-hers who submit this affidavit indicating they are doing ail.corti;md then hire outside contractors utast submit a netr affidavit indicating suds Contractor that check this box must attached an additional sheet shouine the name of the sub-contractor;and state whether or not those entities haw emptorres. If the sub-contractors have empiovez;.iheV must provide their .volleys'Tromp policy number. 1 atrt an emphorer that is provitring npor/ters'compensatiolr insurance for nri•employees Beloit,is the polict•and job sire I71f0T11IUti01L insurance Company Name: p .9 Policy or Self-ins.Lic.� ujd-6'�&o& Sr— Expiration Date_ / / Job Site Address: f' _S^ I) LgA L",rt j R k Citi-/State1Zip: pl . A 6 Llle Attach a COPY ofthe Workers'compensation polisv declaration page(sho%%ring the policy number and expiration date). Failure to secure coverage as required under Section 25A of\,IGL c- 152 car, lead to the imposition of criminal penalties of a fine up to S 1-500.00 andrror one--year imprisonment,as.yell as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 herebr ceeftrf_h it rler the pants acrd penalties ofperjrtlJ•that file information provitled above is trite and correct. Signature: Phone=: `��m Ll 0 - 8 Official Ilse only: Do not write in tills aretl,to be co111pleted Gr city or touui ofeifil Cin or To�cli: Permit/License" Issuing Authority(circle one): I_ Board of Isenith ? Building Department 3.Cit/Town Cleric 4. Electrical Inspectora.Plumbing inspector 6. Other Contact Person: phone�: © DATE(111161M.YYYY) i �U® CERTI=ICK g fc OF L1AG 121€�l INSURANCE 12n82014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVC•LY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOTCONSTIIUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED 1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT-If the ceaificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION 15 WANED,Subject 10 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). PRO13UCER U•NIAL I NARIE: 1 Automatic Data Processing insurance Agency.Inc. PHONE Ex0c (ice ntrk 1 Adp Boulevard aDDREss: ) Roseland,NJ 07068 GISURERIS)AFFORDING COVERIGE N11rc. INSURER A. NorGUARD Insurance Company 31470 INSURED POLAR BEAR INS ULATION CO INC INSURER B. DBA:Polar Bear insulation CO Inc INSURER C: PO BOX 958 INSURER D: Andover,MA 01810 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER 291629 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED B£LOY:HAVE 3EEN ISSUEOTO THE INSUR=E-DNA\;ED ABOVE FOR THE POLICY PERIOD i INDICATED_NOTLYITHSTANIDINGANY REQUIREMENT.TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOCU\3ENT.VITHRES PECT TOWHICH THIS E CEERTFICATE N1AY BE ISSUED ORMAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is sUaj EECTTO ALL THE TER\'S. EXCLUSIONS AND CONDfnON5 Or SUCH POLICIES.LIMITS SHOYdN h;AY HAVE BEEN REDUCED BY PND CLAIN;S. LTR TYPE OF INSURANCE LNSD IYVD POLtCYNU.NBER (r.%jvOtryyY) Ca IDDYYYY) LIIRIS i COMMERCIAL GENEItAL LIABLL(TV EACH OCCURRENCE S CL,NtIS-+lAOE 0OCCUR I'll ERtISESIEaltcw(crcr! S LIED Exp I inY.:e Peucn) S PERSONAL L ADp Ittl uln; GEAZ.AGGREGATE LILIIT APPLIES PER. GENEfbtit ACCRE6A7E RPOLICY❑i ECT r1 LOC PRODUCTS-COLIP.OPCG OTF.Eft S UhsNtu�t t.0 s AUIORMRE LIABILnY iE2.L[ICEI:o I ANY AUTO BODILY INJURY 0-w Izann) S i ,uB0010MYURPcUlC:.nED 1105 ,qfEDuL= HIRED 0 wNEU P • Si ^t if , S UhBREU.IW,*6 OCCUR EACH OCCURItEIiCE EXCESS LIABCL,IGJS;•UU)E IGGItEGATE S DED ItE;En'."N S I S tct7ru C"C u'&6ATtt)N X ST17TUTE FRS AND EMPLOYERS'LmatLrry y IN .1.000,000 MY PROPIUETORx'%I{TtaEt(EXECU-af EL EACHACCIMENT � A OFFICERA.GIEEI{fEClUaO: Y❑N!A N POIVC660990 �OI)D1R015 0101/2016 ELDISEASE-FA EAit•LOY'EE S 1^000`000 R•tmJatatl•b hot) li lea_`IP`n'O`ct 3,000,000'EL.01SEASE-POLICY UrJr S UESCRIPTIOROf CVEI6ITIOMc Ldu,•: DESCRIPTIQN OF OPERA710NS lLCG17lONS?L'EtR0.E5(ACORD]OL Ad,btinnrJ RemzrluSehedu[e.may!x atUched.t. space is nxtuiredl Columbia Gas massachusetts l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Theifsch Engineering,Inc. ACCORDANCE WnHTHE POLICY PROVISIONS_ i 19S Frances Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE A119BB3014ACORD CORPORATION•All rights reserved. ACORD 25(2014,01) The ACORD name and logo are registered marks of ACORD r t CERTIFICATE OF LIABILITY ONSURANCE WAM2015 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, EXPEND OR ALTER THE COVERAGE AFFORDED BY TIME POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TI0-ISSUING NSURER(S), AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: it the certificate holder is an ADDITIONAL INSURED,the poiicypes)must be endorsecl. ff StIBffOGA'fi®t�[S ConfeWAIVErights hts t subject go the terns and conditions of the policy,certain policies may require an endorsement A statement on this Certificate does nog corder rights$fl the Certificate bolder in lieu of such endorsement($)- CONTACT PRODUCER Durso&Jankowski Ins Agcy LLC NAME:PHONE FAT•. 998 Massachusaft Avenue (AM N Ban, r uo North Andover,MA 0984.5 ADDRESS: Durso Janhowskt ins.Agcy. ID 0:POLAR-9 IRSURERIS)AFFORDING COVEFIAGE (\AIC 8 INSURED ®tar Bear Insulation Co.InC. WStMERA:Penn America 32859 p o eon gs wum"afeW insurance Co. 33698 Andover,MA 09810 lNsuRER c. INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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)S SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR rMEOFMSURANCE POLWHUMBER rPdU-CVAEUO EFF WMM POUCYE]IP tltt7TTS GENERAL UABIUTY EACH OCCURRENCE S 9,040,044 A X COMMERCIAL GENERAL uAsiury AC7052023 031? 415 =20211116PREMISES nice s 50,044 CLAIMS 1ADE ®OCCUR MED EXP(Any an PeIST) S 5,040 PERSONAL&ADVINJURY S 1,000,4 GEIaERAl.AGGREGATE S Z000,000 GEMLAGGREGATELIMITAPPUESPER: PRODUCTS-COMPIOPAGG $ 11000,00 El- S POLICY PRO LOC AUTOMOBILE UABILI Y Come[NEDSINGLE LIKIff S 11000,00 Q0928 09/0412095 09104/2098 (Eaecddenl) ANY AUTO BODILY INJURY(Per Person) S ALL OWNED AUTOS BODILY INJURY(Peracddent) $ SCHEDULED AUTOS PROPERw oAMAGE S 3C HIREDAUros (PER ACCIDENT) 3Y NON-0WNEDAUTOS S S UPABREUAUAS I)f OCCUR EACH OCCURRENCE S 9,000,00 EXCESS UAB CLAIMSI44ADE AGGREGATE S � AC694&�5 03/2412095 a3/24P�096 DEDUCTIBLE $ RETENTION S $ WORKERSCOPAPI7dSATMON sUM E ANDEMPLOYERS LIABILITY TO Y UMI ANY PROPRIErORIPARTNERIEXECUTIVE YIN EL EACHACCIDENT S OFACERIMEMBEREXCWDED? NIA Mandawy In NII) EL DI ASE-FAEMPILUOYTEEc S If yes,descdbe under DESCRIPTION OF OPERATMONS belau EL DISEAS_POLICY LIMIT"S OESCRIPTIONOFOPERA'I MILOCATTONS/VEHICLES(AMehACORD9at,Addi onnlRenmrimsehedWARffwrOapacoisregWred) Insulation Work-Mineral;Additional insured for general Ilabli ty"" h IMF= fo work-performed on their behalf by the above inured is Tirieisch inQ CERTIFICATE HOLDER CANCELLATION THiELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 368leiSCIB Engineering THE M(PlRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN S ACCORDANCE WITH THE POLICY PROVISIONS Columbia Gas 195 Francis Ave REPRESENTATIVE Cranston,X102990 AurilaRaEO 46S-11L ©1988-2009 ACORD COl$PORAMON9_ AD rights reserved. ACORD 25(2009/09) The ACORD name and logo are r4lstered marks of ACORD s Regdefio" office of Cons�n��and 10 park - Suite 0216 Boston,lVlassachuSes bion ctor Regi Home yUprovelnent Rection: 1027'26 i 72a016 Tri te OLAR BEAR INSu1.AT'ON CO- Vincent LeBlanc _------ P.O. BOX 958 1810 - mmk rem$for changes ANDOVER, MA 0 = ppdWAdd tr�and return�Emrlome`i ❑Lost Cot 1 Address U Renewal DpS.CAi €+ 0IM6 r-ia -�et�ar rt:nt Q'n -1t711C JaT@?3 9 massach:ts_� ' •apdards Board of Lie if?C! =gu►.afitons arta Cnn,tructittn Supers NOr SPecialt�' License:GRSLAOM7 ZEAST Pin srR�E'r .u zap Plaistow IH 03865 ' Excirat on O4128t2048 commissioner