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HomeMy WebLinkAboutBuilding Permit #901-15 - 15 MIDDLESEX STREET 5/11/2015 0011Th 1 f BUILDING PERMIT 3?b•�r`a�_ °:bio TOWN OF NORTH ANDOVERo APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received Date Issued: If 9SS�CHUs�� IMPORTANT: Applicant must complete all items on this page LOCATION' � � � M ha OLI-1 Y AJL Print 'PROPERTY,OWNER -*AAk',4 L-10 :Print r't MAP NO.' PARCEL:_ ZONING DISTRICT , Historic=District yes (n,,MachVillaine Sho p ge yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 210ne family ❑Addition ❑Two or more family ❑ Industrial iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑.Septic ❑Well ❑ Floodplain ❑>Wetlands ❑ Watershed District -:❑Water/Sewer 1� D r se i PUA-ok� <��* �t�cTu►�dfS 1�Lt�T/�cc (, t �bJ Lc7i' �n.'T (/I�.,n!`I'�A �� !2�7�►PIdK- . �•s�.l. l3Lw�3/J � /�c�.S7�Z � C�'�,byc Zcu� slb�e Identification Please Type or Print Clearly) OWNER: Name: Ql2Y LOW Phone: 97? r580 F223 Address: l s x i 00 I-r, Vix. ANO 0VXA CONTRACTOR reName: �F Phone Address Supervisor's Construction License /4eExp. :Date: Home mprovementbcense �, _ Epp Date: a T .. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED $125.00 PER S.F. Total Project Cost: FEE: $ 2� Check No.: - k// l Receipt No.: NOTE: Persons con ratting with unregi ered contractors do not have access to the gu ranty fund Sig ature of Agent/ Signature of contractor- i� �� �^ NORTH ,BUILDING PERMIT � 6 • �. TOWN OF NORTH ANDOVER :W APPLICATION FOR PLAN EXAMINATION * ,_ - M 4 Coll"0+ Date Received An Permit �epy cy Permit No#: gSSACHus�c Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 1 o Year Structure yes no MAP_PARCEL: ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes. no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑ Industrial ❑Addition ❑ Two or more family ❑ Commercial ❑Alteration No. of units: Bldg ❑ Others: El Repair, Assesso Repair, replacement ry ❑ Demolition ❑ Other p Well ° Flo plain Wetla d ❑ 1Natershed ®istrict r ❑ Septtc _ ` I 1Nater/Sewer,� DESCRIPTION OF WORK TO BE PERFORMED: It Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: ndExp. Date: Supervisor's Construction License: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: rmit Reg. No. Address: ppeals FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F- cording FEE: $ Total Project Cost: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund —A-- n ro.nfrnnt'�ar Or —� AA 4f Plans Submitted C� Plans Waived ❑ Certified Flot : TYPE OF SEWERAGE DISPOSAL- Public Sewer----- � artrr1ent Building Dep tained• he appropriate permit to be°b I, be filled out for t is a list of the required forms to The following abilitat1On Permits Siding lnteriOr Reh Roof ing '. permit App lication , � Building Comp Aff idavitndlor C.S.L. Licenses Workers of H.I.C. A l photo py Perm Co Mork It ' of Contract of Bldg Copy -ed Interior roduaent prior to issuance Floor plan or prop ineered p ering Affidavits fog n ofgf from Fire Dep Engine ulre sign OTE: All dump ster permits req , Addition or Decks permit Application Building urVeyed plot Plan Certified S Affidavit Licenses Ian And 'rkers COMP And C S.L. ith Sprinkler P Wo 0f H.I.0 work" _ � photo Copy osed Plan of prop Copy of Contract able) ble) foss SectionlElevaA pllc Applicable) 6 Flo0TIC ort (If p of Bldg per► raulic Calculationsompliance Rep products o issuance Hyd ck Energy C n ineered p rtment prior t e Eg a ch r CC � Mass Affidavits fo n off from Fire Dep Engineering vire sig • All dumpster permits req o F arnily) pTE. Single and Tw ® ction (Single New Construct lication permit App Building proposed plot Plan uses kler plan P, Plannm; Certified prop And C S.L. Lice S rin l to of H.I.C• it Returned) to Include p pho Comp Affidavit one- O Be ConservE Workers plans But If Applicable) - Vilafier� ;� Two Sets Calculations ( ` Hydra_ullctract DP`6� o of Con code products r to issuance a' Bldg P; Toy copy IE-CC Enefgy ineered p e artment Arlo 2O ering Aff vets for ng from p Board of A ,,FIRE DEP '� Engine (require signOff Fire must stamp the decisionnefc from ,roof$roof of r� Located at 1� stet permits own Clerks office m e istry of Deeds. O and p Fire Depai All dump the then g '4 OTE it was required recorded at 4 perm.' must then get this r variance or special p licant '�COMMEIVT; cases if a over. The app In all eriod is a lication that the appeal ted with the building Pp Trust be subiu 2014 Doc:gnilding permit Revised i BUILDING PERMIT NORr 0 r � s �p ..}. �` .tLED !6 �H �• TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION "z _ h Permit No#: Date Received �R°°RwrEow�Q" c5 .SSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes. no 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 T Sept>c plNellf # gtFloodplanWet[ands 1] UVaters`hedD:istnct s �xDESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: . Home Improvement License: Exp. Date: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sianatu�e ©f��4aent/OOwner=�. �_�.,�. ��'=Sianature�of�c©nt�acto'r C�,...,��-a Plans. Building Department j is a list of the required forms to be filled out for the appropriate permit to be obtained. .ng, Siding, Interior Rehabilitation Permits � Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4� 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 OTE: 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) a. Copy of Contract 2012 IECC Energy code 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 Doe:Building Permit Revised 2014 Plans Subrn Lied Cir Plans Waived ❑ Certified Riot Pldr?:Q . 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS WEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Conservation Decision: Comments N !slater& Sewer Connection/signature& mate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FiIRE DEPAR+TMEIVT Ternp D�um sferon site 'yes - � * nfe I nn tetl at 1.24 Main Streets :` � ;::' . Fire Department s_iqnat relgate ` 3(�i#3�,, ,�v •y'� �..'. _ � �-,�'7@ ���'�' cn, ����� a A��,� �� '• ��' tom? � s ;F• F ".` All V \-` NORTH " �^ �O�,�tLeo aq•y x O Dimension x Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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.$10041000 fine NOTES and DATA— (For department use) r � i LI Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 ' _ T a s ,4 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools _ D i Well ❑ Tobacco Sales ❑ Food Packaging/Sales D 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Y Located at 384 Osgood Street y k FIREDEPARTMENT- - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Q�'�M d 46c 14;0 y 'Ldn zd'i& lin fi r ' F_ , NORTH h ver Mass 2oi5 oKe COCHICNIWICK RATEO PPa,`�5 IJ BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... .1��... ....................................... . ............................................... BUILDING INSPECTOR has permission to erect .............. buildin s on Foundation . Rough tobe occupied as ... ...........................:.............................. 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 ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC 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. F �R A N K FRANK HOWARD 1 CARPENTER & BUILDER 7 H O W A R D Homeowner: Anne & Barry Low 15 Middlesex Ave. North, Andover,Ma April 25,2014 1978-880--8]93 c Builder: Frank l .f o\vard Construction ,LLC 512AVJnSt BOXfOrd,Ma 021921 978-26 -2308 c 978-35?-7604 fax &bus S43659185 HIC #1 ,7191 exp.8/19/16 CSL 1''' 124=1 i exp9/3/16 Conti,Ict Secom' Flom- Bath Remodel: Plum h 1,:g 1i x t u res&Door hardware to be Brushed Nickel, Fixture list from Peabody Supple 1ug.21, 2014 includes towel bars and accessories Install grab bars supplied by owner Perm],.: I or h l u mbing,electrical, building Demo �,.xisting Bath to studs Oper u I door to reconstruct plumbing, location of sink&toilet to be moved to fit new layout Instal' 1 c\N- 1,1umbing for one shower, one Lav, one toilet(reuse existing toilet, , Fixture list fl- I'c,.!)ody Supply Aug. 2014) 512A MAIN STREET, BOXFORD,MASSACHUSETTS 01921 VOICE: 978.352.7604 FAX: 978.352.7604 i v Instal I one new Andersen awning window,complete interior trim & exterior siding size to be determined at rough framing stage Install new toe kick heater at bottom of vanity Electrical :Install one recessed light over shower,install one Nutone fan& lite unit venlcd to eNtcrior,Install homeowner supplied light at mirror,install one gfi receptacle Inspect framing for straight,plumb, adjust accordingly Instal I new insulation exterior to walls( interior walls for sound , inspect ceiling insult:'ion, add new if needed Exist:, ,, door to stay Inst(il' hlueboard and plaster to areas not recieveing tile Inst,.:; 1/2" cement board as underlayment under all tile work except shower floor (mug! .',)b) Const,'uet framing for one approx 32"x 56" copper pan supplied by us Inst,'' ceramic the to slhower floor ,walls and ceiling.Install tile to Bath floor, Inst:-'. -cramic the behind toilet (no other wall tile) Cer�ii� .c the allow 4.00 /ft., Bull nose and deco tiles are Additional cost Dias: ":iI install is additional cost labor and waste Sup; institlI granite top for vanity, same granite to be used for shower seat, thrc- Id to shower Products from Athena Marble & Granite ,Ward Hill, Ma Inst,- new trim to door & windoNv I wi! )nstruc( Vanity. Vanity to be paint grade 3/4 " Birch plywood,maple face frame. Vag. -o have two drawers , one oil top of the other mounted left or right . determined at site Fra r. :_,ss sho\\cr door adlo\v 1200.00 Ins'. Sty, _c of\I,iy 11;2015 Co. ,tion <il)prox three weeks from start 512A MAIN STREET, Bo FORD,MASSACHUSETTS 01921 VoicE: 978.352.7604 FAx: 978.352.7604 w ` Acceptance: The above prices ,specifications and conditions are satisfactory and are hereby accepted You are authorized to do the work as specified. Payment to be made as outlined above. Signature Date—/-//a5—//j Signature rzt� Date �`� B N �dersen ANDERSEN REPRESENTATIVE ' tiV 7 Y eM DATE: /�`�._. JOB ---- ------- a y r a , , £ £ i l s 3 £ , o- E _ V { 1 i C , £ _ _.. . e 3 e � E E .__. ,._.. ._ ...E ` i t I ` s {E r ' E The Commonwealth of Massachusetts ' .._ . Department of Industrial Accidents k. Office of Investigations 'o 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r�qq�,, Please Print Legibly Name(Business/Organization/Individual): T UA K 46w AK o C& R_micGT uw W. Address: 51, City/State/Zip: hA„&ate Phone #: Are you an employer?Check the appropriate box; Type of project(required): 1.❑ I am a employer with 4• am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ['' eemodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' y p tY• 9. ❑Building addition [No workers' comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions rea homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I qu 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' 13.0 Other comp. insurance required.] *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 am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: kAlt 6t✓AZ &'AA66u� //"l k� Policy#or Self-ins.Lic.#: vU G v 2 066 Expiration Date: z Job Site Address: l M-$ $ U 3Z� City/State/Zip: /U`likSD?00+_ 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 hereby certify under thepains anddpfenaltieess ofperjury that the information provided above is true and correct. Signature: /1 /,_/ '�a�- Date: /Lha — Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.•Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more- of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial f insurance coverage. Also be sure to sign and date the affidavit. The affidavit should Accidents for confirmation o s g g be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom h Office of Investigations has to contact you regarding the applicant. of the affidavit for you to fill out m the event the g y g g Please be sure to fill in the permit/license number which will be used as a reference.number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia PtZ,12�3/2014 aCQRQ CERTIFICATE OF LIABILITY INSURANCE LUDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND(CONFERS NO RIQIiT9 UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE$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),AUTHORIZE. REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the cert' tate holder Is an ADDITIONAL INSURED,the poliey(ies)must endorsed. H SUBR 71 i3WAIVED,su ject to the term 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). PRooucER N Emi1Y COS%0j j o COSTELLO INSURANCE AGENCY PNHco u 978.374.6352 arc,No 978.521.5127 2 South Kimball St. ADDRESS ecostellokoStelloinsurance,tom PO Box 5249 INSURERS)AFFORDING COVERAGE NAIL D Bradford, MA 01$35 INSURER A: National Grange Mutual Ins. CO 14788 INSuREO Franlc Howard Carpenter INSURER B: Acadia. 512A Main St. INWRLMO- Boxford, NA 01921 MUICLRD: INSURER E: INSURER P_ ' COVERAGES CERTIFICATE NUMBER-2014 REVISION NUMBER: Tm—j O CERTIFY THAT THE POLI IE INSURANCE LISTED BELOW HAVE BEEN ISSUED T T INSURED NAMED ABOVE FOR THE POU Y VP RIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 6F ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRI13ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE (NSR WVD 1,011.10y NUMBER faI9D1YYY MMM0Iv LIMIT@ GeNERALUAMUTY MPM0078i 09122=14 091 2015 EACHoccuRRENCE $ (,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea troctlrterece $ 500,000 CLAIt S44ADE t-- i OCCUR NW EXP(AIry ax Perron) $ 10,000 A PERSONAL&ADV INJURY $ 13000.000 GENERAL AGGREGATE 8 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOP AGG $ ,OOO,00(1 POLIC9 F1 MET LOC $ J'ccT AUTOMOBILE LIABILI Y M9M0078 07114J2011t 07114P101S Ea aoww , BODILY INJURY(Per pmen) $ zS0000 ANY AUTO A ALLOO�D X SCHEDULED BODILYINJURY(Ps•aeddw* $ 500,000 X IaIREOAUTOS X NON.OWNED IPerebcldern) S 3.00,0 00 AUTOS $ UMBRELLA LIA@ OCCUR EACH OCCURRENCE $ EXCESS LEAH CLAIMS-MADE AeORWATE S _ DED I I RETENTION$ $ WORKERS COMPENSATION WU02WO393401 09(09/2014 CWW2016 TORY LIMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXLCUTIVF YIN N NIA 5,(,•EACWACCIDENT $ 1001000 a OFFICERIMEM@ER EXCLUDED? E.L.DISEASE•EA EMPLOYEE $ 100 0O (Mandstory In NH) If yes desoraae under E.L.Oa$EABE-POLICY LIMIT $ S00,00 DESCRIPTION OF OPERATIONS below W.SCRIPTION OF OPERATIONS I LOCATIONS I VF'IIICLES(Atla h ACORD 101,AddHoeei Rameft Scitedlda,If mate apace 18 requW4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DEWRISED POLICIES'BE CANCELLED @EFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE BELIVERHD IN ACCORDANCE VM14 TME POLICY PROVISIONS, AUTHORtWO REPRESENTATIVE Q)1988.2010 ACORD GO ION 71cdahts reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD ""e"��0/U6/GCI�31`LCl2`�6 i 9 Massachusetts v Department of Public Safety- office afetyOffice of Consumer Affairs&Business Regulation I ME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards egistration 167191 TYPe Construction Supen'isor > - License: CS-042443 xpiration: $/1:9/2016 LLC FRANK HOWARD CONSTRUCTION LLC l FRANK L HOW,40 512A MAIN ST r FRANK HOWARD BOXFORD MA 1192 _ 512 A MAIN ST. �z BOXFORD, MA 01921 Undersecretary � M.� moi_.�rlit Expiration 09/032016 Commissioner ' Location No. / Date L11 J • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ J Building/Frame Permit Fee Foundation Permit Fee $ � ... Other Permit Fee ATED TOTAL $ Check# f 28753 Building Inspector