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HomeMy WebLinkAboutBuilding Permit #395-2016 - 174 GREENE STREET 9/29/2015 �10RTh BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit N0: / ����0 Date Received T �O�A K�KMK `y1,�rqq� / �AATaq 1- Date Issued: CHUg�� IMPORTANT: Applicant must complete all items on this page LOCATION i\JGr+ti, A,-<4 0-y-, Print , PROPERTY OWNER M\yJ ly S C4 hr) / .� Print MAP NO: 0/� PARCEL��ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building IYOne family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer S 4-6 2 Identification Please Type or Print Clearly) OWNER: Name: (y) t kss 2 < < Phone: �f 13--S3o-ill 7 Address: +_ CONTRACTOR Name: Phone: l)' 7 C,Cat Ca Led,W& Address: Supervisor's Construction License: U Exp. Date: r , Home Improvement License: ' Exp. Date: 9 J J ARCHITECT/ENGINEER Phone: Address: 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: $ ��� FEE: $ 116--Sf Check No.: Zoa'1 Receipt No.: 299H ZL} NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor � , .. ■ 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 Call Email Date Time Contact Name i i Doc.Building Permit Revised 2014 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature C COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1 Conservation Decision: Comments ` Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street FIRE DE AP R.MIM - T mp Dum'pster onsite��rayes '` �' no Located at 1-2.41 Main Street Fire Department'signature/date ; {`C,DIVIIVIENIjJ,��•�k.y.,?.r tt�:. 3"ft'- y ,' 74, i e�` .�r n;K:a`�'1 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS ' CONSERVATION Reviewed on Signature G COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments r Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street a:-.--...,- ._..�....._.,..:.�<....-�-•,F"- -ter �. �)FI-RE DEPAR+TME�NE Temp�©umpstenontsitet�y�es.� W 7� � "no ;Located at 124 Main StreetK - 4u Jt:t �.. i' ,7:y t},+� LYS -•�wN,'1 .? .2,� Pre DepartmMt signature/date 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 Call Email Date Time Contact Name Doc.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 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/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 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 Doe:Building Permit Revised 2014 �I NORTFt q BUILDING PERMIT o16t do TOWN OF NORTH ANDOVER o? APPLICATION FOR PLAN EXAMINATION �o 9 �. Permit No#: Date Received "�q,TEo �g gSSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Frin`t PROPERTY OWNER F`rint 100 Year Structure yes no MAP PARCEL: ZONING DISTRICMT: 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 0 Industrial 0 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other p F'loodplain� s:��" - MI Se tic i 1Nell � D '""` ' I;�Wetlands � ► Watershed District N Water/,Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: tea,.. C►ontractor Name: ,, ,� honer IP Email: Address: SupervisPristu-on-structio-nivicen' se: Exp. Date: w n^ s Home Improvement License:. Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature`of°Agent/&Wer Signature Location No. / 7o16 Date 1-112-9 �� e . • TOWN OF NORTH ANDOVER ' SF �n46 a • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 201 29424 Building Inspector r 1NORTH ve' 'o 39 2011 h ver, Mass, c oc«i c„l Mr1C M "4TEO r'PP,`�(5 S V - BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ,G �1., ......, BUILDING INSPECTOR has permission to erect buildings,on Foundation Rough to be occupied as ............5`... .......r....... ...... .1 V10.4.61 ............................................................ Chimney provided that the person accept this permit shall in every resp t 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 M TH ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO 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. �G�FII�t(/P� �C 01Q0![iClp�� Craig LaCrosse-Owner ` ESTIMATE PO Box 728,Tyngsboro MA 01879 September 2, 2015 978-580-7376 craig@roofingkinginc.com Customer: Mike Asselin Address:174 Green Street,North Andover MA Postal Code:01845 Phone:413-530-5117 Email: mikeasselin@icloud.com Thank you for allowing Roofing King Inc.the opportunity to work with you. Here is a list of the work to be completed,the agreed price and payment structure. Please feel free to contact me with any questions or concerns at the number listed above. SCOPE OF WORK: Full roof replacement -House will be covered with roofing blankets to prevent any damage and for easy cleanup -Remove all shingles right down to existing wood and re-nail and prep before installation process begins -Install up to 96sq ft of rotted plywood(3 sheets 1/2 roof plywood)at no charge on any full roof replacement&$50 per additional sheet if needed -Install 6 ft of GAF Storm Guard ice and water shield leak barrier along base of roof and areas listed below -Cover all valleys,snow load areas,under all flashings,wrap all penetrations including but not limited to chimney's and sky lights -Remove and re-install new plumbing flashing on soil pipes vented through the roof -Install Felt Buster on any exposed wood before shingles are applied -Install new 8" (color)drip edge on all edges of roof for proper protection -Install GAF Pro Start starter strips around entire perimeter of the roof to create a 1/2 inch overhang for proper install -Install GAF Architectural Timberline HD LIFETIME Ltd.Shingles will be storm nailed with 6 nails per shingle 130 MPH resistance -Cut 11/2 inch opening on peak of roof if it wasn't previously done for proper installation to meet building code(on full replacements) -Remove old lead around chimney and reinstall 12 inch lead and reseal joints(if applicable) -Install Cobra exhaust vent on peak of roof to allow proper ventilation and meet building code -Hand nail Seal A. Ridge caps on peak of roof with 2 inch nails to complete installation. -Blow off entire roof,driveway and all walking surfaces and clean any loose nails with 3 ft rolling magnets daily or on completion -Clean all gutters and downspouts(if applicable) -Existing roof will be removed and recycled at Roof Top Recycling(Certified Green Roofer) Job Specifics and Upgrades (on full roof replacements) -Weather watch upgraded to Storm Guard Ice and Water Shield $0.00 Included -Remove skylight flashing kits to install ice and water on all 4 sides(reinstall existing kits) $0.00 Included -Deck Armor in place of Felt Buster $250.00 Not Included -Garage roof $1,600.00 Included -Install white circle vents along the soffit $350.00 Included Warranty Roof comes with 50 Year Weather Stopper System Plus LTD manufactures warranty Promotions Military,Veterans and Retirees receive a$250 Rebate through GAF when purchasing a GAF Lifetime Roofing System. PAYMENT STRUCTURE: This price includeslabor,material,trash removal,building permit if required and contract may act as signature for permft. (Any additional work will require separate pricing) Make all checksPaY able to Roofing King Inc. Total: $10,050.00-$500 Act Fast Coupon(Exp.9/30) $9,550.00 Deposit(due at signing): (1/3) $3,183.00 2 Payment(due when material is onsite): $0.00 Final payment(dueon job completion : (2/3) $6,366.00 SHINGLE COLOR: �le w+ i� r4-ninitial: Q ACCEPTANCE OF PR POSAL.The included specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above and accept all terms included. All discounts on all work to be done must be presented to Roofing King Inc.representative before contract is accepted. If rotted wood is discovered AFTER removing the existing roof,or it could not be identified at the time of sale an additional charge of$50 per sheet. If this account is collected through legal actions,customer will be responsible for all attorney fees and court costs. Disclosure:Customer responsible to cover any valuable items in the attic to protect from debris.Roofing King does not assume responsibility for acts of Mother Nature. r _fv" Owner/Contractor, Property Owner Craig LaCrosse Mike Asselin The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbem TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization4ndividual):Roofing King Inc Address:Po Box 728 City/State/Zip:Tyngsbom MA,01879 Phone#: 978-580-7376 Are you an employer?Check the appropriate box: Type of Project(required): 1.❑1 am a employer with employees(full and/or part-time).• 7. ❑New construction 2.a 1 am a sole proprietor or partnership and have no employees working for me in $. Remodeling any amity.[No workers'comp.insurance required.] 9• ❑Demolition3.[:]l am a homeowner doing all work myself[No workers'comp.insurance required.] 4111 am a homeowner and will be hiring contractors to conduct all work on my property.ro I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole l L[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.a I am a general contractor and t have hired the sub-contractors listed on the attached sheet. "mese sub-contractors have employees and have workers'comp.insurance.: 13.aRoof repairs 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.00ther 152,§1(4),and we have no employees.[No workers'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 aro doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-oontractors 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 is providing workers'compensation insurance for my employee& Below is the polky and job site information. Insurance Company Name:Star Policy#or Self-ins.Lic.#:WC 0742797 Expiration Date: 81w Job Site Address: ?L/ (0)r D^ 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 MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,y p so»ment,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.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 the pains and penalties ofperjury that the information provided above is true and corree% Signature: ct� -4 Date: cS Phone#:978-580-7376 Official use only. Do not write in this area,to be completed by city or town ofcid 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#: AC O� DATES `,� CERTIFICATE OF LIABILITY INSURANCE 3/13/2015 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 CONS I IME 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 berms 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 endorseme s. PRODUCER Melissa Warren Risk Strategies Company PHONE ( FAX (781)963-4420 15 Pacella Park Drive E Suite 240 INSYI S AFFORDING COVERAGE NAIL 0 INSURED Randolph MA 02368 INSURERA:Scottsdale Insurance Co BauRERB:Guard Insurance Grout) JUaioz T >a Construction INSURER C: 406 Bridge Street INSURER D: #3 INSURER E LowellMA 01850 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1531391061 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. LTR TYPE OF INSURANCE POLICY NUMBERPOIUCYEXP @@NPPnNYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY = 100,000 A CLAIMS�NADE ®OCCUR 81914893 /11/2015 /11/2016 MED EXP one on $ S1000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE S 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X1 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea ao*wm ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Per eodderd) $ HIRED AUTOS q�-0�D PROPER E S S UMBREL ALIARHCLAIMS4AADE OCCUR EACH OCCURRENCE $ EXCESS UAB AGGREGATE S DEO RETENTION S B WORMN COMPENSATION $ AND EMPLOYERS,LIABILITY WC STATU OTH- ANY PRGPRIETOR/PAxrT+ER�EXE(x1TiVE YIN 100 000 OFFlCERIMEMBER EICCLUDED7 N 1 A E.L.EACH ACCIDENT $ (Myamtddoq In N 2TI627911 /11/2015 /11/2016uncler E L DISEASE-EA EMPLOYE S 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 5QQ QOQ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(AUsch ACORD 101,AddNknM Rernaft SeIIMIlp,M mora spate b nwp Irsd) Rvidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roofing Ring, Inc. ACCORDANCE WITH THE POLICY PROVMM. 12 Malvern Avenue Tyngaboro, MA 01879 AUTHORIZED REPRESENTATIVE !Michael Christian/MSG --- ACORD 25(2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. INS025(2moosyo1 The ACORD name and logo are registered marks of ACORD r , L Rd CERTIFICATE OF LIABILITY INSURANCE °O-TIE2 8!20/2015 THIS CERTIFICATE 13 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 folder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the berms 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 andomeme s. PRODUCER McSweeney&Rica Insurance Agency, Inc. PHONE FAX 20 Washington Street E-MAIL Arc o:N P.O.Box 850984 Braintree MA 02185 INSURER(S)AFFORDING COVERAGE NAIL A ENSURER A INSURED �y Regional Insurance Com ROOFK-1 MsuRER e Star Insurance Company Roofing King Inc INsuRERc Craig LaCrosse PO Box 728 RMRER D Tyngsboro MA 01879 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:677678720 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. IN TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP WVDImmoffym UMTS GENERAL UABILJTY Y Y CGL 0059562-21 12/11!2014 12/11/2015 1 EACH OCCURRENCE SIODOODO X COMMERCIAL GENERAL LIABILITY $100000 Cl A1MS#MDE a OCCUR MED EXP one $5 DOD PERSONAL 8 ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GENL AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPlOP AGG $2000000 X POLICY PRO LOC $ C TALL LIABILITY Y MIT577OF 8120/2015 8!2012016 Ea atscihttt 1 000 ODD LIN I O BODILY INJURY(Per Person) $ ED SCHEDULED X AUTOS BODILY INJURY(Pleb soddent) $ UTOS X AAUTOS D DAMAGE $ $ UAB EXCESS X 00 OCCUR 0071022 12/11/2014 12/11/2015 EACH OCCURRENCE $2000000 X EXCESS LIAB CLAIMSWDE AGGREGATE $2.000.000 DED RETENTION I $ e WORD COMPENSATION WC074279703 8/2012015 8120/2016 we sTATU- X OTH AND EMPLOYERS'LIABILITY Y 1 N ANY 0 CER/MEIMBEXCLUDED? NN RIEXE-CUTIVE —] N/A E.L EACH ACCIDENT $500,000 (Mandatory In NH) KyesdeWbe under E.L.DISEASE-EA EMPLO $500 000 DESCRIP ION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 00411 ACORD 101,AdMonM Ramada&hef*.N more spates b reQ ftm Roofing(commercial and residential)and siding operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MOLL BE DELIVERED IN Roofing King Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 728 Tyngsboro MA 01879 AUTIIORQED REPRESENTATIVE ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD '1 masoachuse"s Depar-,Mct--! P! Pubitc Safe-, H Board of Butld)nq RcqtAja!!on5 w-d Sianziiras Office of Consumer Affairs& Bus4e"Re"gulatio'n Constructive Suptrvtwr I & 2 Fannih OVEMENT CONTRACTOR _:cense: WA-101415 173117 Type. 914=16 Private Corporallc CRAW A LACROM 12 MALVIM A ROOFING KING INC. TYNGSBORO MA 0 CRAIG LACROSSE 12 MALVERN AVE TYNGSBOR0,MA 01879 Vacirmcretary 0612MIS Y� ba xt F-Kl- T ;AA 51�14"1;- kill