Loading...
HomeMy WebLinkAboutBuilding Permit #710 - 171 PLEASANT STREET 6/19/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: (�✓ ,y �` �� IMPORTANT: Applicant must complete all items on this pace LOCATION Print PROPERTY OWNER T -Print MAP NO: 4 PARCEL:,,)3_ 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: Z Commercial air, replacemet> Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: j c 4e � t %I Phone: Address: 1-7/ ,_ 1'Vc% G- --a :p" CONTRACTOR Name:,a,,,,, mc-* Phone: 'F24 c ev- Address: iu byy &I /4-1-- ,1_71".s4 e. I- aiAL,;: l �r �'- G► Supervisor's Construction License: G-% J4 Exp. Date: f �e-d Home Improvement License: / 6-1 ARCHITECT/ENGINEER Address: Date: Phone: Reg. No. FEE SCHEDULE: BULDING PERMIT: MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. !.i d Total Project Cost: $ !Z3 70 FEE: $— Check No.: Receipt No.: r { NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor.. �t� 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 I COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS i Reviewed on Signature i I I 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 Osaood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 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 must 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 Location �7��� 7— No. No. -7/0 Date �l NORTH TOWN OF NORTH ANDOVER f � ,O? • • oow D // # i Certificate of Occupancy $—,— �'�s cHEco' Building/Frame Permit Fee $ s�us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # asa 22'i -:j 1 Building Inspector O J O w cn x w r4 u X. x 0 a w w o m Cc w FF Ir cG O cn Q cn O J z O U co Cm CO2 O CD — •7E m m CD O O CL CD O OL C3 16. CL m CD CL a. cmQ c cc o c C O CO3 Z CD C..3 y c C _ C •� C CO2 0 D vI uj CA W W 19 W U) .c c o me :oma Cc rC O v V :•C.� :cc �= o O L :yrM :_:5w... V CDCCOL4 CJ • cm CD c E mmCCr; L O �► C:.D. 3 S v, cm CDn US CO t C C N O O Emmo a�.,� i m MO) e` cm nit m :m Nor v O LO Z W O p CL cm c Q j � CD i m C •O x ~ m .1m 3 N ni m COD w0• m w0+ 'p L W O .a r.• t y... cm +.+ w y � o= E a.=W.c Ic.D, �vi Z LAJ C.2= a O� Qo Q Vi as a H C _ � =�am� z O U co Cm CO2 O CD — •7E m m CD O O CL CD O OL C3 16. CL m CD CL a. cmQ c cc o c C O CO3 Z CD C..3 y c C _ C •� C CO2 0 D vI uj CA W W 19 W U) The Commorrwealilt of1t machusetts Department of Industrial Accidents Office of Investigations 600 Nlashington Street Boston, M4 82111 www_n2asr»gov/dia . Workers' Compensation Insurance kffidavit: Builders/Contractors/Eieatricians/plumbers Appbcant Informatinn Name (Business/prgeiai2ation/lndivid¢sl): eg Aci=ss: City/Sta&zip:_.07 —/�z � T h Phone #:� Are you an employer? Cheek.the appropriate box: 1. � am a emplayer with 4. ❑ I am a general contractor and I employees (full and/or part time).* 2. ElI have hired the sub -contractors am .a.sole proprietor. or partner- ship and have no employees listed c ni the attached sheet. _ These sub -contractors have working for me in any capacity. [No workers' comp. itimirance workers' comp. insurance. 5. ❑ we are a corporation and its required.] 3.❑ 1 am a homeowner doing officers have exercised their all work right of exemption per MOL myself [No -work=' comp. q 152, § 1(4), and we have no insurance required.] t ..employee=s. [No workers' comp. insurance renuired.] Type of project (required): 6. Now construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Budding addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13j] .Other 'Any appiicam that checks box'# I must atso fill out the section below ahowing their workers' bompmutim, poltoy mfommEton. t tiameowners who submit this a'ffi'davit indicating they are doing an worts and then hue outside contractors must submit a new affidavit indicating such " iCoatraetors that check this box must a_r� an additional sheat showing• the name of the sub- cormactaes and their workers' cat.^.,. p u— iniommtion �� r. . I W errrpuryer fear is psnviarng : workM $ cornpensatrori insurance or infornratiorc m1'PloJ' !!plow is the policy andjoh site . insurance Company Name: Z 4 Policy # or Self -ins. Lic. 3 sl 7 �� J Expiratim Date: 7 Job Site Address: /`7 l - / '2.3 X1,-1 Attach a copy of the workers' compen;ai#on policy declaration page (showing the policy comber and expiration date}. , Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal pena}ties of a fine up to $1,500a d and/or one-year imprisonment, as well as civil penalties in the form of a STOP V+�DRiC 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 a Investigations of the DIA for insurance coverage verification. I do hereby c under the pains and penalties o e ' iP rJ+ay that the information provided above is true and eorr a Si tore: Date: Phone #: C' [I.Bo�ard ial use only. Do not write in this area to he co b fficiaL mPl-d or town o or Town:Permit/License # s Authority (circle one): of Health 2. Building Department 3. City/TownCierk 4. Electrical Inspector 5. Piumhiag Inspector erct Person• Phone #: t Information a. nd Intstructions Massachusetts General Laws chapter 152 requires all emp loyers 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." I' An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'fbmgaing engaged in a joint enterprise, and includirikg the lepi representatives of a deceased employer, or the receiver ortrustee-of an individual, partnership, association or other legal entity, employing employees. 'However the owner -of a dwelling house having not more than three apa-anerft and who resides thenar, or the occupant of the dwelling house of another who employs persons to do maimtenance, construction or repair work on such dweiiinghouse or on the grounds or building appurtenant thereto shaU nat because of such ernployment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state o•a- local licensing agency shag withhold the issuance or renewal of a license or permit to operate a business or ito construct building in the commonwealth for any applicant who has not produced acceptable evidence air compliance with the insurance 'coverage required." Additionally, MOL 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." Applicentis .. . Please fill out the workers' compensation• a$idavit compi4entely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), ad&ess(es) ELnd phone number(s) along with their certificate(s) of insunince. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, arc not requuzdlo cant' workers' compensation insurance. If an LLC or UP does have empioyees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'Ere 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 Departman t of Industrial Accidents. Should you have any questions regas-ciing the law or if you= required to obtain a workers' oompensation policy, pleasecail the Department at the nurnber listed below. Self-insured companies should enter their Self-insurance triune number on dre'appropiiate tine. 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 sura to fill in the permittlicense number which xk-0 be used as a reference number. In addition, an applicant that must submit multiple pmmit/licww applications in any given year, need only submit one affidavit indicating current policy infonnation (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 offieiaily starnped 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 iicemse 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 Departmcnt's address, telephone and fax number: The Commonwcmlth of Massachusetts Department of lmdustdal Accidents Office of Investhi stions 600 Washington Street Boston, MA 02111 TeL # 617-7274900 exit 406 or 1-977-MASSAFE Fax # 617-727-7749 Revised 5-26-05 w'wwMass.gov/dia Proper Owners: Joyce Cegelis 171.173 Pleasant Street North Andover, MA 01845 Dominique's Construction, LLC 25 Glennon Avenue Dracut, MA 01826 978-957-6308 CONTRACT AGREEMENT Entered into this 9th day of June, 2009 between Dominique's Construction, LLC (hereinafter "Contractor") and Joyce Cegelis (hereinafter "Property Owner") of 171-173 Pleasant Street, North Andover, MA. The Owner and the Contractor, for the consideration hereinafter stated, agree to the following: 1. Scope of work to furnish and install 36 new Low -E windows at the above noted address of Property Owner. 2. The Contractor will provide all materials per estimate. 3. The Contractor to supply all labor for the work to be done per the estimate PAYMENT SCHEDULE • Dominique's Construction, LLC to provide material and labor for thirty-six (36) windows for the total amount of $9,370.00. • ,000 0 ep sit with $8,370.00 at completion of work. t Dominique's Construction, QX Roland A. Dominique Ms. Joyce C ells Property Owner k Of Date AFFO Meets or exceeds EIEC, CET S IECC Air Infiltration Requirements WOMA Hallmark Cartlfieatl.n P..or as f, INC. I S� o� SL---1 S s co.. or ua al. f / 1 , i �FRC MFG CODE: SIL NFRC NFRC SIL. -N-005 Series 9500 Dual Glazed PA"CouNb^ Vinyl Double Hung ,gpe ARGON LowE3 oa ENERGY PERFORMANCE RATINGS U—Factor Solar Heat Gain Coefficient 0.30 1.7 I 0.21 (U.S./I-P) (Metric/SI) ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air Leakage 0.49 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whde productperformarce. NFRC ratings are determined for a fixed sat of environmental conditions and a specific product size. NFRC does nd recommend any product and does not warrant the suitability of art/ product for any specific use Consult manufacturer's literature for other product performance information. wwwnfrcag 6 WINDOW AND DOOR MANUFACTURERS ASSOCIATION wwW.Wdma.aom 440—H-070.01 Silver Line Windows 9500 SERIES DOUBLE HUNG Manufacturer Stipulates Conformance to the f.LLO ING STANDARDS S TAN DAR D MAY I NIG AAMA/WDMAICSA 101/I.S.2/A440-05 H—R45 45 x 63 in DO +45/-45 psf FL 7599.2 TDI—WIN-396 Glazing 3.0 me Double Sir AN Outer/ 7.0mm Double Str AN Inner R0/R0 NOON Complies xlth HUD UM Bulletin 11.3 Meets or exceeds EIEC, CET S IECC Air Infiltration Requirements WOMA Hallmark Cartlfieatl.n P..or as f, INC. I S� o� SL---1 S IVB t?t��€ Construction Supervisor License License: CS 44201 Expiration: -4/20/201. 0 Tr# 21480 �'Restrictioia: UQf 7/. Board of Building Regulations and Standards -- HOME IMPROVEMENT CONTRACTOR Registration: 151738 i Expiration: 6/26_ /2010 . Tr# 267918.. ` Type: Ltd Liability Corpor t DOMINIQUE'S CONSTRUCTION, LLC. ROLAND DOMINIQUE 25 GLENON AVENUE i DRACUT, MA 01826 Administrator i ROLAND A DOM1NlQllE 25 GLENNON AVE DRACUT, MA 01826-- "-�' Commissioner x ACC>R& CERTIFICATE OF LIABILITY INSURANCEFDATE(MMIDDIYYYY) 00 PRODUCER GEORGE GATH INSURANCE AGENCY, INC, 703 CHELMSFORD ST LOWELL, MA 01851 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. " (978)454-7728 POLICY EXPIRATION YY INSURERS AFFORDING,COVERAGE NAIC # INSURED DOMINIQUE CONSTRUCTION LLC 25 GLENNON AVE DRACUT MA 01826 INSURERA: Liberty -Mutual Group INSURER B: INSURER C: INSURER D: INSURER E: C;OVERAGE5 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE AT / Y POLICY EXPIRATION YY LIMITS REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Eldridge �• ��'�''/-� C�'uC C'�. GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurrence $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR MED EXP An one person $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG - $ POLICY PCj LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY OCCUR FICLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NFIR PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? a WC2-31S-359739-018 7/4/2008 7/4/2009 1 WC SLTATU IM OTH- DRYANY E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYE $ 5500000 (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The workers' compensation policy provides coverage only for the state of MA as noted in section 3A of the policy. CFRTIFICATF Him nFR c1kM1 P1 I ATIAu AGURD 25 (2009101) ©1988.2009 ACORD CORPORATION. All rights reserved. SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 7 DAYS WRITTEN 1600 OSGOOD STREET NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NORTH ANDOVER MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Eldridge �• ��'�''/-� C�'uC C'�. AGURD 25 (2009101) ©1988.2009 ACORD CORPORATION. All rights reserved. DATE(MWDD/YYYY) L --- CERTIFICATE OF LIABILITY INSURANCE 6/11120C PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GEORGE GATH INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 703 Chelmsford St Lowell, MA 01851 (978)454-7728 INSURED DOMINIQUE CONSTRUCTION LLC ROLAND DOMINIQUE 25 GLENNON AVE DRACUT, MA 01826 INSURERS AFFORDING COVERAGE INSURER A Lloyd I s INSURER B: INSURER C: INSURER D: INSURER E: NAIC # 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR LTR D'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MMIDD LIMITS GENERAL UABILITY EACH OCCURRENCE $ 1 0 0 01000 DAMAGk_ IQ ERIE PREMISES Ea occurence $ 50,000 ][ COMMERCIAL GENERAL LIABILITY CLAIMSMADE Fx—J OCCUR MED EXP (Any one person) $ 51000 A LGL0816083 10/12/08 10/12/09 PERSONAL& ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1 000,000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT $ (Ea aoddent) BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANYAUTO AUTOONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CICLAIMSMADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WSTATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? TORY LIMITS PER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE. $ (Mandatory In NH) I( es, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CARPENTRY/PAINTING/TILE WORK/DRYWALL/SIDING TOWN OF NORTH ANDOVER 1600 OSGOOD ST. NO ANDOVER, MA 01845 ACORD 25 (2009/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR The ACORD name and logo are registered marAs of ACORD CORPORATION. All rights reserved.