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HomeMy WebLinkAboutBuilding Permit #422-2016 - 15 ROSEDALE AVENUE 10/5/2015 NORTH BUILDING PERMIT °�t�`E° ,b 6 0 5� TOWN OF NORTH ANDOVER F - APPLICATION FOR PLAN EXAMINATION ,P M y1 Permit No#: 716 Date Received AT gssgcHUs��,�5 Date Issued: I < IMPORTANT: Applicant must complete all items on this page LOCATION HJT I5 lvvio S�Q�1P Print PROPERTY OWNER ZAv� S Print 100 Year Structure yes nDO MAP O q? PARCEL: ev 3 2 ZONING DISTRICT: �` 3 Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ErGne family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i] Septic ❑ Well ❑ Floodplain ❑Wetlands 0 Watershed District Ei Watet/Sewer DE�91RIPTION OF WORK TO B PE FORMED: 26e /V 0 d Identification- Please Type or Print Clearly OWNER: Name: S10(otf e.f Phone: ?7� Address: Contractor Name: T<WO /��-''�� Phone: & 17. Email: Address r, O rc��ljof- �-- Supervisor's Construction License: •qO /;S Exp. Date: Home Improvement License: 1 /d Flo 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: $ 42 0-?c7- d"U FEE: $ Check No.: o "1 Receipt No.: 2��, 1 1 NOTE: Persons contracting wit unregistered contractors do not have access tot uaranty fund i _ e& 13-iqnature of co Plans Submitted ❑ flans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swvnming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(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 Signature COMMENTS HEALTH Reviewed on Signature COMMEO.-S 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 DPW Town Engineer: Signature: Located 384 Osgood Street A )iREtDEPARaTt ENT Temp _ .-v ►yeS, M"t dat'12� Dempster onsite ;.T (nbt `? � Coca e ,, _4tMainrStreet= - ... AFire�Depar#ment signature/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: lies No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA-- (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit 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 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 4. 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) 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 Doc:Building Permit Revised 2014 4,Location / AGS le N,- r42,)2,)--2 /,d Date 1q S / . • TOWN OF NORTH ANDOVER PLED j69 4 . . Lertificate of Occupancy $ Building/Frame Permit Fee $� E Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ' � Building Inspector t%ORT1i own Of t EAndover p 0 No. 4,�a— 2Ai oh ver, Mass, COC..Ic KEwicK y�• �d RATED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System JL THIS CERTIFIES THAT ............. .......! BUILDING INSPECTOR . .... ... ... .. .. has permission to erect .......................... buildings on ...J..5.......k1k.Ns.C.A.^j.`..... .. ,�,t....... Foundation Rough to be occupied as ...........8­1... .�� .. ... .4 ................................. 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 CONSTRUCT I STARTS Rough . ................................. Service ............... ................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildinz 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. Renewal MA Home Improvement Contractor byAndersen. Renewal b Andersen Corporation License#170810(Expires 12/23/2015) WINaaW aretaetMr.NT ■n a+..lerrnG,w+.,v yFederal Tax ID#41-1918413 30 Forbes Rd. Northborough,MA 01532 (508)351-2200 Fax(508)-986.7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyers Name Date: LAURA SHOTTES - AUGUST 26, 2015 Buyer(s)Street Address citv State ZipCode 15 ROSEDALE AVE, NORTH ANDOVER MA 1 018+45 email Address Home Telephone Number Work/Cell Telephone Number LSHOTSIE AOL Com 978.682-7528 617.850.2903 Buyer(s)hereby jointly and severally agrees to purchase the goads andlor 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 atter Contractor has completed all work under this Agreement. e Total Job Amount $ 12,273 mount Financed S 12,273 Est.Start DaM!Whgd of Egyment Deposit Received(33%)$ 0.00 Deposit at sign'sig S 6,136.50 Check/Cash f0-l2 weeks Balance Start of Job(33%)$ 0.00 Chock k Balance on Substantial At Substantial Es?,Install Tittle Credit Card Completion of Job(33%)S 0.00 Completion S 6,136.50 1-2 days a credit card is selected,please No final melt shat be demanded unto all les are seavaed see Credit Card Payment form Buyor(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 forms of this Agrooment. No alteration to or deviation from this Agreement will be valid without the signed,written consent of both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyor(s)1)has mad 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 l3uye(s Buyor(a) By: �I!GC(ii L IL --,v Signature of Consultant Signature Signature x BRUCE PECK LAURA SHOTTES Printad Name of Consultant Printed Name Printed Now 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 OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. ------------------------------------- ------------------------------------ I NOTICE ar CANCEra.ATION NOTIOE OF CANCELI.tTION 1 Dale of Transaction a/tri/15 .You may cancel this I Date of Transaction 0/21./U. You may emeel than trauaaclion,without any penalty or obligation,within three business days from die i transaction,without any penally or obligation,within three business days from the above date.If you cancel,soy property traded in,any payments made by you underI 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 negatiabte Instrument executed by you wit be returned within 10 days fotlnwing 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 arliing out of tine transaction will be t cancellation notice,and any security Interest arising out of lite transaction wDl be canceled, If you cancel,yon most make avallable to the Seller at your residence,in 1 canceled, if you cancel`you must make available to the Seller st your residence,In substantially no good condition au witm received,any goods delivered to you under I substantially ait good condition as when verelved,any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with tine Instructions of the I this Contract or Sale;or you may,If you wish,comply with the Instructional of the Seller regarding the return shipment of the goods at the Seller's expense and rink. 1 Seller regarding the return Nkipment 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 1 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 I within 20 days of the date of your Notice of Cancellation,y»u may retain or dispose of lite goods without.any further obligation. if you fill to make oke goods avail*bte of the good*without any further obligation. If you fall to■nska the goods avaRable to the Seller,or if you agree to return the gnoda to the Salyer and fail to do so,then to the Seller,or if you street,to return the goods to the Seller and fan to do sol then you remain liable for performance of all obllgadona under the Contract.To cancel you remain liable for performance or all obligaHona under the Contract.To cancel this transaction,mail or deliver a Nigard and dated copy of this cancellation notice I this,tranvaction,mall be deliver is signed and listed copy of this eancellation notice or any other written notice,or mead a telegram to Contractor.Renewal by Andersen,1 or any other written notice,or send a telegram to Contractor. Renewal by Andersen, 30 Forbea Rd. Northborough,MA 01532. I 30 Forbes Rd.Northborough,iINtA 01532. I Y EMY CANCEL THIS TRANSACTION. t 1 fIERERV CA.\CELTIUS TRANSACTION. I 1 n.o+rsignnetimi MIN N." aM.. eu04tpwn _- adntN— Dr. I Renewal Renewal by Andersen Corporation MA Home Improvement Contractor byAndersen. 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 1V23/2015) WINDOW REPLACEMENT ..A..,k—.C--,.. (508)351-2200 Fax;(508}986.7072 Federal ID#41-1918413 Window Specification Sheet 13nyer(s)Natne Date of Agreement LAURA SHOTTES WED, AUG 26, 2015 The buyer{s)listed above hereby joindy and severally agree to purchase the goods and/or sewices listed below.in accordance with the prices and terms described on the Specification Sheet and the font and die reverse of the accompanying CUSTOM XVINDMV.A\1D DOOR REMODELING AGREEME\T,of whidi the Specification Sheet is part- WINDOW&DOOR DETAILS FFR FFP• Apex ExteriorAmenor_ -Color Hardware Hardware ---- LarEnr GT11e Grn''k Glass Room # tvl�h heyrc UI. WutdowlDoor S e Detail Casings Ext-Int cow Style Saeens Smart=un Grilles sash in Sash 2 LHts Options Bed s 101 1 36 54 90 DB sq rail equal insert sloped sM L-Trim NHmH White Standard HTS 3fronSur GBG 412 4/2 Yes Bed 2 102 1 36 54 90 DB sq rail equal insert sloped sill L-TrimNI-MH White Standard HTS ur Gets 4/2 4/2 Yes Bed 2 103 36 54 90 OB sq rail equal insert sloped sd L-Trim NKWH White Standard HTS 3=nSur GBG 4/2 4/2 Yes Bed 3 104 36 54 90 DB sq rail equal insert sloped sll L-Trim NKMH White Standardl HTS bmartsur GBG 412 4i2 Yes Bed 3 105 36 54 90 DS sq rail ual insert sloped sat L-Trim NWvVH White Standard HTS n . GBG 441 4/2 Yes Bath 1 106 28 38 66 OB sq rail equal insert sloped sEl L-Trim NHAVH White Standard HTS r GBG 4/2 4/2 Yes Temper Bed 2 107 28 38 66 DB sq rail equal insert sloped sal L-Trim NHNvH White Standard HTS tff GSG 442 4/2 Yes Temper Kitchen 108 41 40 81 GW fug harm rafo Int/Ext MF 908 NKNVH White Standard FTS rt&r GM 4f2 4/2 Yes notes Total a BA BOW&BUILD OUT DETAILS Style Oetaa 4 , dy Approx. Nunber Face wildow EndCenter LntoE/ Roof/ Hardware Room Count Style Fiankens FSI (�tsips Arlge Lftes Interior EmNk t Calor Gr"as sashes sashes Stxtxrls Smartsm Soffit Cola SPECIALTY MNDOW DETAILS Fun/ Approx tow£r specialty BAY/BOWADDITIONAL.WORKNOTES Room count style Insert UL Srnarrs. Grilles Grille Style ExtMt Color GStVpDH is—m Lha wily m•/hcrr•win`lews un&r i2 inrlc tl>crwin tic sig, nt 0-,k1 ADDITIONAL WORKDETAILS: 110 knows 808 on hYtchen.will look di ereaat on out side. HO want kitchen int.trim pyrptimed. I No Contractor will LyM exterior casings with coil stock color of Owneris aware that Contractor does not do any painting/staining or removal/installationn of alarm system or window heafinents/hardware.It is the responsibility of the homeowner to have the alarm system and window treatmentslhardwwe removed prior to installation. LN@ make no guarantee as to whetheralarms or window ✓ treatments/hardware MH ft after replacement Customer is also aware in some cases there will be glass loss. H there ig the amount will be dependent on the type of existing windows,type of insta0ation and window style.We make no guarantee as to the amount of glass foss.Customer is aware and understands any and all unseen rot is not included in this contract.Should any rot be found there"I 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,stone 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 perntits. The fee for the penrit(s)Is Included in the total contract price. J Yes All discounts have been applied to this agreement G If, Y-1 No Owner agrees to be present on the final day of installation for final Inspection and to deliver final payment I finance form(s). It is age ed and utukxstoml byand hetwwrcn the parties that thi,Sperification Sheet along with the CU.STO\f AV NOON'AND DOOR RF-MODYL.ING AGREP AILNT.conniunes doe entire Dndemandin.q between doe pink-,and dtety are no verbal utxdersmidings(thanging or modifying any of the tentc.This Specife:ation Sheet tnav nothe changed or its tents modified or vantd in anyway unir�..~itch tdlatrgm are in waiting and signed bq both the HU%r(s)rutd Contractor.Atwer•{s1 hett`Ix ael:run�icdgc thre.BuyePs?has read dein Specilication Shec:t. Renewal by Andersen Corpora7tiion/ Btnvr(s) ` 1111yer(si //�� Signature of Consultant Signature Signature BRUCE PECK LAURA SHOTTES Print Name of Consultant Print Name Print Name .r 00 nht tmnsye X19 timl sods kspmdm.9m M111 foriuhne w mce 3 I • n � � I i I c :nemslw�rfan• y c• C, e w LM n i ul Quwmlmftbam •�.sy fu .� - � i Renewal.' ndemen I, w1Mnow .QLAC VW A.6.C.,.., ' AND-N-35 WGb WoodMnyl Cam its FF• i Mal Argon Smarf.Sun i PmductTyps: Grader ENERGY PERFORMANCE RATINGS I U-Factor Solar Heat Gain Cceficlent 0:29 : 1.65 SSP amass 0.21n . ADDITIONAL PERFORMANCE RATINGS i VAslble.Transmittance • i 0.49 RICe�7rw f�mfWMlrflflf�Mfnws llllfl,ff,•Cl:,lffftl•L � ' fmK1�N.Mlnvta.fr�n.wlsn.r�/•e,ll�wrayq�w� I w...mff bOOf/ffffw,lf�ft^111f�1a�11•�Il i o,c ow i . r faufnnrA m � Sla,ldard Ra" j i I so i t rmf.M.-W.. i ' +hfti�iwra� j 100-00512035-015 i i • V I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov>dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/Zip: NORTHBORONA 01532 Phone#: 508-351-2200 Arejou an employer?Check tate appropriate box: Type of project(required): I.MI am a employer with 30 4. ❑ 1 am a general contractor and I 6. ❑ New construction. employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 1 7• 'VRem.odeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. El Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its officers have exercised their I0.❑ Electrical repairs or additions required.] 3.❑ .1 am a homeowner doing all work right of exemption per MGL 1 I.0 Plumbing repairs or additions myself. [No workers'comp, c. 152,§I(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box 41 must also till 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. +Contractors that check this box must attached an additional s1fet showing the name of the sub-contractors and their workers'txnnp.policy information. I am an employer that is provr"Wng 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 30543700 Expiration.Date: 10-01-16 Job Site Address: a 0'0 'ov✓"P City/State/Zip: 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 r the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: 68- 51-2200 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 M ANDECOR-01 YADAVYO ACRO CERTIFICATE OF LIABILITY INSURANCE FDATE(M10/1/120152015YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Willis Certificate Center Willis of Minnesota,Inc. PHONE c/o 26 Century Blvd A/c No. o Ext:(877)945-7378 FAAic No): (888)467-2378 P.O.Box,TN 37 n DRESS:Certificates@willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 INSURER E: 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 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. INSRADDL Sm LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDY/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR MWZY 305440 10/01/2015 10/01/2016 EDAMAGE 10 RFNTI_UACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ E4g,OOO,000 ,000 — MED EXP(Any one person) $ ,000 PERSONAL&ADV INJURY $ ,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ X POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: AUTOMOBILE LIABILITY Ea BINEDtSINGLE LIMIT $ 5,000,000 A X ANY AUTO MWTB 305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STATUTE EORH A ANY OFFICER/MEMBER/EXCLUDED?ECUTIVE (� N/A MWC30543700 10/01/2015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) I '� If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 4- �'•� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-M125 ``til:ll_ti /3� ` , JAM L MORIN,;'- 86 GARMER ST LYNN MA 0190f )I,lit�J Expiration Commissioner 10/06/2016 (92. Oke of Consumer Affairs. BasinessUegntation pMl`IMPROY� T CONTRACT0it Registrab . :tt - Type. Bit�ta 11i3+b5: Supplement r RENEWAL BY ORATION JAIME t10,4N `. 104 0TIS STRIEET '' _ NORTHBOROUGH,MA 01532 fJfldersecretary t