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HomeMy WebLinkAboutBuilding Permit #412-16 - 18 DARTMOUTH STREET 10/1/2015 pORTI{7 BUILDING PERMIT ,r�:� `ao 06'•�°0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ; �* Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page p LOCATIONPrint PROPERTY OWNER ,- - - ON n P int j MAP NO: PARCEL: ZONING DISTRICT: Historic District yes sae' Machine Shop Village yes lae� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑One family ❑Addition Two or more family ❑Industrial ❑Alteration No. of units: 3. ❑Commercial Vtepair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑Other Septic C:Well ['Floodplain I Wetlands [7 Watershed District I Water/Sewer 1' Identification Please Type or Print Clearly) OWNER: Name: Phone: 9 Address: CONTRACTOR Name: Phone: 417 60 4'45 , Address: _56 ` \\ e M _ tY�Q\� �c�►,lll Am.J0UV-VJ_I-\ a ® I Ct t`� Supervisor's Construction License: Exp. Date:' ' Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO�SyTfBASED ON$125.00 PER S.F. Total Project Cost: $�, Q J3 � FEE: $ I I Check No.: a�Z Receipt No.: NOTE: Persons contracting with unregistered co actors do not have ac ss io .he guaranty fund Signature of Agent/Owner nature of contractor BUILDING PERMIT TOWN OF NORTH ANDOVER oa APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received R �gSSAC Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT- Historic District yes no Machine Shop Village yes no j TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location No. 44 'r Date • - TOWN OF NORTH ANDOVER Fn ��' . •: Certificate of Occupancy $ Building/Frame Permit Fee e Foundation Permit Fee $ ° Other Permit Fee $ TOTAL $ Check# U bot4ing Inspector � J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL i Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS I CONSERVATION Reviewed on Signature J COMMENTS i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT - Temp Dumpster onsite 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) I ❑ 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 re dumpster permits p p quire 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 o 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) o Building Permit Application a 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�;bmitted with the building application Doc:Building Permit Revised 2014 NORTH own of E ndover 0 No. 4 * = - �` ih ver, Mass COCHIC HI WIC/t � 01 S U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ,... .. e. ,,,,,,. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings n .jer........ -101.1. .al. . .. .................. Rough tobe occupied as ............ ..r. ........... ........................!I!........................................................ 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 CONSTRUCTIO T S Rough Service ................. ... ........ .. ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Equity Builders Addin¢Value To Your Home Kevin and Wendy Rennick Jim Freve 14 First Street Contractor/Carpenter Amesbury.Ma.01913 ® 56 WHiteball Road Amesbury.Ma.01913 License#88727 Kitchen Renovation, 18 Dartmouth Street Scope of work to include: 1. Obtain approval and permit for indicated work 2. Remove old cabinets 3. Remove sheetrock in kitchen and dining room 4. Remove non-load bearing partition wall 5. Removed 2 double hung windows, install header and prep wall for patio door 6. Install patio door, including exterior finish 7. Oversee and direct rough electrical and plumbing work by others 8. Insulate, prep walls for sheetrock 9. Install 3/8"sheetrock over existing ceiling in kitchen and dining room 10. Reinstall sheetrock on interior walls 11. Tape and fill and sand ceiling and walls 12. Prime all new drywall 13. Install kitchen cabinets/Cabinet crown and trim not included 14. Apply finish paint 15. Lay cement board as subfloor for tile in kitchen 16. Tile And Grout 17. Install appliances 18. Dispose of all debris 19. Schedule and conduct final inspection Note: • Additional charges may be incurred after demolition if unknown conditions exist • Permitting for plumbing and electrical to be completed by others • Cabinets to be furnished by others • Patio door and tile to be purchased by homeowner Labor and Material $10,053.00 Page 1 of 4 Total contract price and payment schedule The following schedule will be adhered to unless circumstances beyond the contractors control arise Work scheduled to begin after permit approval Expected date of completion 10/30/15 The contractor agrees to perform the work, furnish the material and labor specified above for the sum of: $10,053.00 Payments as follows: Payment Schedule Contract Signing 20% $2,010.60 Completion of demolition and rough framing 20% $2,010.60 Interior work brought to prime 20% $2,010.60 Completion of work specified in contract 30% $3,015.90 Approval of final inspection 10% $1,005.30 Total $10,053.00 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies of the contract should go to the homeowner and the contractor. 3 dcs Homeowner's Signature/ Date Contractor's signature/ Date Homeowner's Signature/ Date Page 2 of 4 You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. See attached notice of cancellation for an explanation of this right. Required Permits The following building permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: Building Permit NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c. 142A. NOTE: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, Ma. 02108 (617) 727-8598 ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute:to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in M.G.L. c.142A. Contractor: . 41%4� Date: 3 C31 , a S Homeowner: Date: 9 Homeowner: Date: NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. Page 3 of 4 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANYPAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT 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 WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DE5PO5E OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO 50, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: James Freve Equity Builders 56 Whitehall Road Amesbury, Ma. 01913 NOT LATER THAN MIDNIGHT OF September, 16, 2015. I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: Date: Buyer's Signature: Page 4 of 4 Pantry Base 15' 3 $321.30 Drawer 24' Base 24' Base 24' Base upper Base $227.75 $227.75 $227.75 $215.46 90' $250.43 Refidgerator High 36wx33dx70h g 153 1/2' 113' 9/16' 20 1/2' 18' Base Stove 18' 3 18' 3 $185.22 Drawer 36' Sink Base Dishwasher Drawer 37 9/16' $269.33 $223.97 $269.33 1 69' 18' 34' J 43. 82' Office of Consumer Affairs&Business Regulation-Mass.Gov https://services.oca.state.ma.us/hic/iicdetaiIs.aspx?txtSearchLN=85321 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) • Consumer Affairs and Business Regulation s Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration# 183297 Registrant EQUILTY BUILDERS Name JAMES FREVE Home Improvement Contractor Address 56 WHITEHALL RD Registration Home Page City, State Zip AMESBURY, MA 01913 Expiration Date 09/28/2017 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search ©2012 Commonwealth of Massachusetts. Mass.Gov@ is a registered service mark of the Commonwealth of Massachusetts. 1 of 1 10/1/2015 8:39 AM The Commonwealth of Massachusefis 1J. Departtaaent of IndustrialAccidents X Congress Sheet,Suite 100 Boston,MA 02114-2017 www mass goy/dict Workers'Compensation Insurance Affidavit:Builders/ContractorsfFIectricians/Plumbers. TO BE FILED WITH TBE PERMTT'1NG AUTHORITY. Applicant Information ` __`` Please Print Legibly Name(Business/Organization/Individual): �u;���U \CJ� , eV Address: � �—(�)�ni �2�a�1 94 City/State/Zip: AMR56Y u • Phone#: ��$" G G q q 5-02 Are you an employer?Check&e appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. [(New construction 2.Vam a sole proprietor or partnership and have no employees working for me in 8. [�jlemodelfiig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3-[-]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ROOF repairs These sub-contractors have employees and have workers' comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have nci employees.[No workers'comp.insurance required.] `Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit`this affidavit indicating they are doing all work and then hire outside contractors must siibmit a new affidavit indicating such. ?Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,4liey must provide their workeis'comp.policy number.' lam an employer tliat is pidviding•workers'compensation insurance for my employees.'.below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: f 0&t1W10(,4, City/State/Zip: {� 1 . /� 114* (�a, c%- Attach a copy of the workers' compepsation-policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under MOL o.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby crte under lie ins and penalties ofperjury that the information provided above is true and correct. Signature: Date: l Phone#: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of"t-ire, express or implied,oral or written." An,employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth,for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out-the workers' compensation affidavit completely,by checking the-boxes that apply to your situation and,if necessary,supply sub-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 fox 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,not the Department of Industrial Acciden(s. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department•at the number listed below. Self-insured companies should'enter-their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom 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 will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia -� EQUIT-2 OP ID: CA ACORO DATE(MM/DD/YYYY) `.,.� CERTIFICATE OF LIABILITY INSURANCE1 09/23/2015 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 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). CONTPRODUCER Phone:978-388-2354 NAME: Christine Amenta _ Gould Insurance Agency,Inc. Fax:978-388-5578 PHONE FAX ---- 7 Market Square ac No Ell:978-388-2354 (AJC No): 978-388-5578 Amesbury, MA 01913-2494 A DRESS:christinea@gouldinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Merchants Insurance Group INSURED Equity Builders INSURER B: James Freve DBA 56 Whitehall Road INSURER C Amesbury, MA 01913 INSURER D: 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, IPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD SUER POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BOP1086672 08/14/2015 08/14/2016 DAMAGE RENTED 500 00 PREMISESS(Ea occurrence) $ _ _� CLAIMS-MADE FX-1 OCCUR MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO jECTLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ �AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ ---- — HIRED AUTOS AUTOS Per accident 1 $ � UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A — (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under —' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Location:18 Dartmouth St, No Andover Mass CERTIFICATE HOLDER CANCELLATION TOWNNOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE G4�Ve6t.,O ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) 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-088727 JAMES FREVE 56 WHITEHALLRD iI AMESBURY MAI a-01913 R c i' Expiration 05/22/2016 Commissioner i