The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #605 - 1600 OSGOOD STREET 5/12/2009 I BUILDING PERMIT r10RTF/ o`tt�P.o ,6gtio TOWN OF NORTH ANDOVER F24�':y''- '" °. APPLICATION FOR PLAN EXAMINATION Permit N0: �J �°� Date Received 4 ,�5 g �gSSAArea CHU`�E� Date Issued: �2 o / IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER - , Print MAP NO: PARCEL: ZONING DISTRICTHistoric 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 1 Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DET IPTION OF OR TO E P EFORMED: � e 14offification P ease Type or Print Clearlyl OWNER: Name: _ , ., , ��' Phone: Address: 1 - CONTRACTOR Name Phone: -11 Address: %- < 'T t Supervisor's Construction License: q o' L Exp, Date:10/a.�.;/,01-i Home Improvement License: Exp. 'Date: � f ARCHITECT/ENGINEER �r-�i/ � s,s �� Phone:��`;> ,�Sj y _ Address: l�� rr_ ��ir �'�� Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ J� �o FEE: $ "'- Check No.: Receipt No.: �--Z' a 62 n NOTE: Persons contracti egistered contractors do not have access to the guaranty fund Signature of Ageryt/Own Signature of contractor ; - - 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS A10 CONSERVATION Reviewed on Signature COMMENTS %,QHEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes a Planning Board Decision: Comments r"Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS " i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA– For department use ❑ Notified for pickup - Date I ........................_....._...._..................................................__......_...............__._ ..............._.._._...........................—.._.....__..................._._._.........._......._._.._._...................--......--...............-------..........__ Doc.Building Permit Revised 2008 l' Building Department � 9 p 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 NOTE: 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/Crossection/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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 mu'sf then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 � M CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 605 (5/10/09) Date: July 16. 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street MAY BE OCCUPIED AS Tenant Fitup for School Dept. Ste 3-59 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Ozzy Properties 1600 Osgood St North Andover MA 01845 Building Inspector ,tAO R T►y Town of O ..Yu. 0 (OM. No. ps -_ - - T dover, Mass.,— 16, T O Ao — LAKE COC MICMEwICK V 7d AOOATE D O'*1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... ........, 5t' l' .. ...... .A. :.............�....+J....I................................................................ Foundation has permission to erect........................................ ................................. Rough.. ra build! z,��_. Chimney tobe occupied as r...... s ........: ... :................. ..... .............................................. provided that the person accepting this p mit shall in every respect conform to the to sof the application on file in Final 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: On 6/ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTSTr ......................................................................................................... .. !C BUILDING INSPECTOR _V? a � Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. Y SEE REVERSE SIDE Smoke Det. HVAC SANITARY .0 ELECTRICAL McCABE ASSOCIATES Consulting Engineers ELEELEFIRPROTECTION 75 GOODH[TE ROAD,DERRY,NH 03038 Tel:(603)437-2002 Fax:(603)437-01.23 July 15, 2009 Gerald Brown Inspector of Building Building Department 1600 Osgood St. North Andover, MA 01845 RE: North Andover School Admin Offices 3rd Floor Osgood Landing 1600 Osgood Street North Andover, MA MECHANICAL& ELECTRICAL FINAL AFFIDAVIT certify that the HVAC and Electrical work associated with the North Andover School Admin Offices project and that to the best of my knowledge, information, and belief the work was done in conformance with the provisions of the Massachusetts State Building Code and all other pertinent laws and ordinances. Steven Houle 46743 Engineer Mass. Reg. No. 75 Goodhue Road, Derry, NH Address Lj S Jul H OF� 15 2009 ��P Is, STEVE o R. U - �c/S T ONAL E v 9 NE 1-800-256-7264 Co.,Im FAX (603)964-8885 P.O. Box 770 131 Lafayette Rrd. No. Hamoton, NH [13862 (803), 964-8140 OZZY Properties 7;'16109 1640 Osgood Street LLC 1600 Osuood Street North .Andra er, Nl ass. 0184 ,Attn: Bob archer Re: North Andover School Space 00e—Jz, 13oh, P1e.ase use: this letter to certify that the neti fire al.artn device installed and progrcarnnaed at the above space were tested and found to 'he in vwrking order on Fnd.v July 1€i,2001. E'1e<�sr re\ie\v and ii'vou should have any oue4tions please do not hesitate f<> Contact nt4. ��. Jo athan I'It . 'dent ................ UL 0 40 0 9001 p' Systems:Municipal sir R;arrrm and Security Industria Fire Rarm & Security s r .._................_�J k , +i TOWN OF NORTH ANDOVER Final Design Affidavit Project Number: 0812142 (Architect's Job Number) Project Title: North Andover School Administration Offices Project Location: 1600 Osgood Street 3nd floor bldg 20 South Name of Building: Blg 20-3 South Nature of Project: Fit-up of new tenant space. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith Registration No. 8688 being a Registered PFefessi nal Engineer Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural XXXX Structural Mechanical Fire Protection Electrical Other(specify) FOR THE ABOVE-NAMED PROJECT, AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I HAVE PERFORMED THE NECESSARY PROFESSIONAL SERVICES AND EITHER MY REPRESENTATIVE OR I HAVE BEEN PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK HAS PROCEEDED IN ACCORDANCE WITH THE 1 DOCUMENTS SUBMITTED FOR THE BUILDING PERMIT, AND SHALL BE RESPONSIBLE FOR THE FOLLOV.-ING AS SPECIFIED IN SECTION 116.2.2 1. Review for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Revie•.v and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the state of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a I manner consistent with the construction documents. I AM SUBMITTING THIS FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE i PROJECT FOR OCCUPANCY. A Signature and Stamp(no facsimile) �5.��►Efl AP. /T No.8688 NORTH AJ�OOVER JANET L.EATON NOTARY PUBLIC OOURINYMTH OF MASSACHUSETTS 4 My Cw=.Expose Sept 17,2015 Al Of SUBSCRIBED AND SWORN TO BEFORE ME THIS N/� DAYOF_J_0W 2009 MY COMMISSION EXPIRESI7, QO/ TARY PUBLIC NORTH own 0 over And . T No. 6 os over, rIx 1,: '6 0 LAKE. Mass., E,.,,C. COCHICHEWIC ORATED 17 % BOARD OF HEALTH Food/Kitchen Septic System PERMIT T. BUILDING INSPECTOR Foundation THIS CERTIFIES THAT... ..............;�,--3-1........... ...................................................................................... ... Rough has permission to erect...................... . . ........ buildings an ........... ................ZH...�Jr.. Chimney /r to be occupied as......... ......... .............. . .....1. respect conform to the terms of the application on file in Final provided that the person accepting this permit shall in every this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of PLUMBING INSPECTOR Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ........... BUIL6ING**INSPECTOR Final .Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE Smoke Det. REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents y Office of Investigations y 600 Nrashington Street ti Boston, MA 02111 www_nzass.gov/dia . Workers' Compensation Insurance Affidavit- Builders/Contractors/Electricians/'Plumbers Applicant Information Please Print LeQibl Nanie(Business/Organization/individual): Address: /;7f /7 ___ City/State/Zip: G9 eNe dz �s aim Phone#:_. 2 g' dQ D 7p�_ Are you an employer?Check the appropriate box: i•❑ I am a em to er with 4. Type of project(required): P Y �� ❑ I am a general contractor and I - employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a:sole proprietor or partner- listed on the attached sheet.t ?• S-Reif 5deling ship and have no employees These su&contractors have 8. ❑Demolition for me.in any capacity, workers' comp.insurance. [No workers'comp. insurance 5. 9• ❑ Building addition p ❑ We are a corporation and its Electrical required.] officers have exercised their 10.❑ repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself.[No-workers'comp, C. 152, §1(4),and we have no 12. Roof .. insurance required.].t -employees. ❑ repairs [No workers' I3.❑Other comp. insurancerequired-] 'Any applicant that checks bo)'#I must also fist out the section below showing their workers'cam tpensalion homeowners who submit this affidavit indicating they are doing all work and then hie outside c ntractors must submlicy it a new affidavit indicating such. — ;Contractors that check this box must attached an additional chaershowing. the name of the sub-contractors and their workers`camp,polis,infomation. t mn an eMPloyer that is providing:workerscompensation insurance for my employee- Below is the policy and job site . information. - Insurance Company Name: ' 7— Policy#or Self-ins.Lic.#: p G Cd Expiration Date: Q Job Site Address: D Cit dstatazip: Attach a copy of the workers''compe's 'on 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. 1 do hereby certtify under thepains and penalties of perjury that the information provided above true and carred Si tore:.✓ /� � Date: O Phone k Fal useonly. Do not write in this area,to be completed by city or town o�ciaL n: Permit/License# ority(circle one): ealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Pl=traj son• 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 workerscompensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for-the permit or license is being requested,notthe 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 numberlisted 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 of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which Krill 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 fziied 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# 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia Construction Supervisor License s �4 License: CS 48040 r ^; Birthdate; 10/29/1955 J *', " Expiration: 10/29/2009 Tr# 5601 I ftestric,.tfori: 00 f TADEUSZ DOVVGIEERT I I 175 BRADY AVE SALEM,NH 03079 II Commissioner TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: 0812142 Project Title: North Andover School Administration Tenant Fit-Up Project Location: 1600 Osgood St, Building 20,Third Floor Name of Building: Building 20 Nature of Project: Fit-Up of tenant space In accordance with Section 116.0 Registered Architectural and Professional Engineering Services-Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith Registration No. 8688 being a Registered Professional Engineer/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural XXXX Structural Mechanical Fire Protection Electrical Other(specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE. ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the state of construction to become, generally familiar with the progress and quality of the work and to determine in general, if the work is being performed in a manner consistent with the construction documents. UNDER SECTION 116.4, I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS,TO THE ANDOVER BUILDING INSPECTOR UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY CO READINESS OF THE PROJECT FOR OCCUPANCY. YPA Signature and Stamp(no facsimile) c� N"lam, Mk SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 2009 �t— MY COMMISSION EXPIRES NOTARY PUBLIC 10/28/2008 13:35 FAX 19786833147 X.P.ROBERTS INSURANCE X1001 CERTIFICATE OF LIABILITY INSURANCE QATE(MMIDD/YYYY)10/Z8/08 PRODUCER THIS CERrIRCATE IS ISSUED AS A MATTER OF.INFORMATION M.P. Roberts Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1060 Osgood Street NDLDER. THS CERMICATE DOES NOT AMEND. EXTEND OR 9 ALTER THE COVERAGE AFFORDED BY THE POLICIIM BELOW. North Andover, MITI 01845 INSURERS AFFORDING COVERAGE MAIC 0 MISUREO INSURERA. Providence Irhatu81 DOWGIERT CONSTRICTION CO. , INC INSURER 9:Guard Insurance 616 ESSEX STREET INSURER C: LAWRENCE, MA 01841 INSURER D. INSURER Q COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE 9BEN ISSUED TO THE INSURED NAMEO 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.E)CLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INWI POLICYNUMBER EffFCTfVE POLICYETIPIRATION LIMITS GENERALLIABiLINY EACHOOCURRENCE S 1. OO 000 DAMAGE TO RENTED X COMMERCALGENERALLABIU7Y S 100.0 0 CIAMSMADE r n e OCCUR MED EXP awpmanS 5,000 A CPPOO64437 10/26/08 10/26/09 PE RSONmAADvtNAURY s 00 000 _ OENERALQQ RIOffE S 2,009,000 GEN'LAGGREGATELMITAPPLE.SPM PRODUCTS-CONPOPA03 is 2,000,000 POUCY WC AUTOMOBILE LIABILITY COMBI NED SN GAUMIT AHYAUTO (I3NaddwNI S ALL"ED AUTOS BOOILY N JURY SCHEDUIEDAUTOS 1parFa—) s HIREDArros BODILY HAIRY (Parasidmi) NON4"EDAUTOS S PRCPERTY0wIACE s — {Rxaalaen) GARAGELABIUTY AUTOON.Y•EAACCDBYT $ ANYAUTO OTHER THAN EAACC S AUTOONLY: AGO S EIMESSAIMBRE.LALA8ILITY rACH0CCURRENCE��_ S OCCUR CLAMS MADE AIZGRS3AYfl i S . i OEDUCTISLE Y s RETENTION S S WORKERS COMPENSATION AND TSTA GTN• EMPLOYERS'LABILITY B ANY PROPRIETOWPARTNEfVEAECUIIVE DOWC911544 10/26/08 10/26/09 ELBICHACGOENT 7 1.000.000 OFFICGRMBNEREXCLUDEDT EL,DISEASE•EAEWUNEE i 1,000,000 ° � z ,b„ ELDIWASE-POUCYLMIT S 1,000,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT ISPWA&PROVISIONS F-603-458-1090 I CERTIIiCATEHOLOM CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER DATE THEREOF.THE ISSUING INSURER WILL CC40MOR TO MM 10 DAYS WRITTEN 1600 OSCOOD STREET NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT,BUT FAYWRE TO 00 60 SHAIA NORTH ANODVER, MA 01845 IMPOSE NO OBLIGATION OR UASIUTY OF ANY KiNO UPON THE INSURER,ITS AGENTS OR REPRE99WATIVM i AUTHORIZED REPRESENTATIVE I i ilk y p, ACORD 25(2001108) ®ACORD CORPORATION 1988 i I Location No. C, tate 0�/2 NORTH TOWN OF NORIH . 00 f 9 Certificate of Occupancy $ ,ITS CHUS t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22U '/ U /� tuilding Inspector