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HomeMy WebLinkAboutBuilding Permit #447-11 - 194 OLYMPIC LANE 11/29/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER rd h U- h Print MAP N(1 PARCEL:1Qk ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building i6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Nteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic D weFloodp a no's pWetland t�OWa ershedlp=istrict ' '� "...,��'. 4. y ' ' 4t. _ Ttt'� _•,. b?'T's'"1Ys3.';c ' j t . { ®Water%S were _ ` YDESCRIPTION OF WORK TO BE PERFORMED: o At Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: A [-I)&n 's_1� � I Th Phone: q7�-333 Address: Q h V4 WS J Supervisor's Construction License: -733-7,5 Exp. Date: 9 /3/ 2,0 /Z Home Improvement License: 103(,011 Exp. Date: 7/1l /Z®/L ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ .r Check No.: �T�O a Receipt No.: W5-4- I NOTE: Persons contracting with unregistered contractors do not a access Jo the guaranty fund i nature,ofA ent/Ownera: Si nature:of_`nfracto �.. -g-- -_--=g - ---- — Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL !' Public Sewer ❑ Swimming Pools ❑ I' Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS . I HEALTH Reviewed on Signature ,r OOMMENTS 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 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 i Electrical Inspector Yes No I 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 - Date Doc:.Building Permit Revised 2008 I I I 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 ster er mits 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals ia!t the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording [a St be submitted with the building application Doc: Doc.Building permit Revised 2008mi Location + L -G... No. —_` Date NpRTM TOWN OF NORTH ANDOVER o H i �a Certificate of Occupancy $ �ss,kMU,E<� Building/Frame Permit Fee $ J. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23741 - Building Inspector T6AndORTH 01" ® _ over C% l _tL- LAK n dover, 1Vlascs COCMICMEW1 K �A. 7�ADRATED pP�t"`CO 1 u ` BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THISCERTIFIES THAT............... ....... r��✓ -....... ..... G.�d�. ...................................................................................... Foundation has permission to J erect........................................ buildings on ..Rq.....vt.. .N.-44.G......te+*z........................... Rough t0 be OCCUpled as........ . . Chimney ............. ......... ... .. ....•... provided that the pers accepting this permit shall in every respect conform to the terms of 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. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TAR^ Rough Service f BUILDING INSPECTOR Final r� ��. t Occupancy Permit Required t0 Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the- Premises — Do Not Remove Final No Lathingor D Wall To Be Done FIRE DEPARTMENT` Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. �\, '' BR WN-S KITCHEN & BA THC N S 15 Elm Street * Danvers, MA 01923-2058 Mailing address: 72 Holten Street, Danvers, MA 01923 Telephone(978) 774-3333 * Fax(978) 774-8709 Home Improvement License#103611 * Mass. Builders License#073375 CONTRACT This contract,dated below,for materials and/or labor to be supplied by Browns Kitchen&Bath Center (Hereinafter,referred to as the contractor),at the sole request and order of: NAME: Sarah Keogh PHONE: 1-978-502-5535 DATE: Oct.8,2010 ADDRESS: 194 Olympic Lane N.Andover,MA 01845 (Hereinafter referred to as the owner or buyer)to be supplied/performed at premises set forth above,subject to all of the terms and conditions set forth on both sides of the Agreement,as follows: Brown's Kitchen and Bath Center is happy to furnish you with a quote on your Bathroom project Master Bath Carpentry:We will remove the wall to the left of the shower to allow for a 36 x 36 shower. We will frame a new wall;this wall will have new blueboard and plaster.We will also patch where needed. We willsupply and install new base trim in room after flooring is replaced The shower wall will be an acrylic unit by Sterling. We will supply and install a vanity size: 30 A DrQM 4- knobs are included with vanity. 3,4 N� The vanity will have a Corian counter top with integral bowl(this could also be granite) Above the vanity will be a recessed medicine chest Flooring: The floor will be prepared for owner supplied and Brown's installed tile. Plumbing: We will disconnect all fixtures. We will supply and install a Sterling 36"shower base and walls We will supply and install a Symmons tub valve Model#S96-2 We will supply and install a Kohler 8"Forte lave faucet. We will disconnect and then reconnect existing toilet All work to be connected to existing plumbing.If any upgrades are needed a quote will be provided. Shower Door:We will supply and install a Sterling shower door or equal.Allowance is$800.00 this includes the installation.(Please note that shower doors can take 2-4 weeks after template) Heating:We will replace the baseboard heat.Installing it on the outside of the wall and patching the wall. Ventilation: We will vent the existing fan to the outside. Electrical:None at this time:this will be quoted, *Tile quote is based on a straight installation.Intricate patterns are higher in price for install.Marble like tile is a higher price for install. *At time of job all knobs,handles, TI'holders,towel bars etc. roust be on site for installation.If not on site during job installation a service fee will be charged to'return to job and install these items. Nothing other than stated above is included in this quote No paint orpaper.All sales tax is included All work is fully insured Any debris created by Browns will be disposed of by Browns.Local permit fees not included (C" -Ti I t_ Ct�tt, tij ���J At 6'i ►5 SurcQ� ar S�Cc�t-I�nc� Door Style ra 4Z d A/ln �� �AGREED PRICE: $9,800.00 Handle/Pulls Floor 1/3 DEPOSIT: Counter 131 V L/-zalj BALANCE DUE: This quote.is-good-for.(30)Thirty Days.from date above. The oHTner represents and warrants that he is owner of aforesaid premises and that he/she has read this agreement,set forth on both sides. IT IS EXPRESSLY AGREED THAT NO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN, EXRESSED OR IMPLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT. Itis further agreed that this contract is not subject to cancellation except by written consent of both parties. SALESPERSON: ACCEPTED: ACCEPTED BY: X X (SUBJECT TO ALL CONDITIONS ON THE REVERSE SIDE). BR 0 W N'S KITCHEN & BA TH C NTE, 15 Elm Street * Danvers, MA 01923-2058 Mailing address: 72 Holten Street, Danvers, MA 01923 Telephone(978) 774-3333 * Fax(978) 774-8709 Home Improvement License#103611 * Mass. Builders License#073375 CONTRACT This contract,dated below,for materials and/or labor to be supplied by Browns Kitchen&Bath Center (Hereinafter,referred to as the contractor),at the sole request and order of: NAME: Sarah Keogh PHONE: 1-978-502-5535 DATE: Oct.8,2010 ADDRESS:194 Olympic Lane N.Andover,MA 01845 (Hereinafter referred to as the owner or buyer)to be supplied/performed at premises set forth above,subject to all of the terms and conditions set forth on both sides of the Agreement,as follows: Brown's Kitchen and Bath Center is happy to furnish you with a quote on your Bathroom project: First;floorbath tl w ZbMW1> Ball 8f Carpentry:We will supply and install a vanity sizer knobs are included with vanity. The vanity will have a Corian counter top with integral bowl.This could also be Granite.(some granites may cost more) Above the vanity will be a mirror. Floorin : We will remove the existing floor and the floor will be prepared for owner supplied and Brown's installed tile. Plumbing: We will disconnect all fixtures. We will supply and install a Kohler 8"Forte lave faucet. We will disconnect and then reconnect your existing toilet once the floor is complete. All work to be connected to existing plumbing.If any upgrades are needed a quote will be provided. Pleating:We will replace the baseboard heat.Installing it on the outside of the wall and then patching the wall where needed Electrical:We will install owner supplied light. Laun Irv:_.We will remove the washer and dryer,remove the flooring and prepare the floor for owner supplied and 10 ' --------------------- 1700. Brown's installed tele We will then re install the washer and dryer.. $ 00 *Tile quote is based on a straight installation.Intricate patterns are higher in price for install.Marble like tile is a higher price for install. *At time of job all knobs,handles, Th holders,to)vel bars etc.must be on site for installation.If not on site during job installation a service fee will be charged to return to job and install these items. Nothing other than stated above is Included In this quote.No paint or paper.All sales tax is included Alf workIs fully insured Any debris created by Btowns will be disposed of by Browns.Local permit Fees not included. Door Style k/6UV-& "Gra AGREED PRICE: $4,800.00 bath $1,700:00 laundry Handle/Pulls N© Floor 1/3 DEPOSIT: Counter Gy2Q/LL16 _��-� BALANCE DUE: This quote is good for(30)Thirty Days from date above. The owner represents and warrants that he is owner of aforesaid premises and that he/she has read this agreement,set forth on both sides. IT IS EXPRESSLY AGREED THAT NO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN, EXRESSED OR R PLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT. It is further agreed that this contract_is not subject to cancellation except by written consent of both parties. SALESPERSON: ACCEPTED: ACCEPTED BY: X X (SUBJECT TO ALL CONDITIONS ON THE REVERSE SIDE) r o BR WN S KITCHEN & .BA 7H CENTER 15 Elm Street * Danvers,MA 01923-2058 Mailing address: 72 Holten Street, Danvers, MA 01923 Telephone(978) 774-3333 * Fax(978) 774-8709 Home Improvement License#103611 * Mass. Builders License#0 733 75 CONTRACT This contract,dated below,for materials and/or labor to be supplied by Browns Kitchen&Bath Center (Hereinafter,referred to as the contractor),at the sole request and order of: NAME: Sarah Keogh PHONE: 1-978-502-5535 DATE: Oct.8,2010 ADDRESS: 194 Olympic Lane N.Andover,MA 01845 (Hereinafter referred to as the owner or buyer)to be supplied/performed at premises set forth above,subject to all of the terms and conditions set forth on both sides of the Agreement,as follows: Brown's Kitchen and Bath Center is happy to furnish you with a quote on your Bathroom project. Hall Bath 2nd Floor Carpentry:We will remove the walls in the tub area to the studs. We will supply and install a Sterling acrylic tub and walls in white.The walls around this unit will be finished with bleboard and plaster. We will supply and install base molding around the room We will supply and install a vanity size:60"(knobs are included with vanity). -u L 4atw.i The vanity will have a Corian counter top with integral bowl(this could also be granite) Above the vanity will be a mirror Flooring: The floor will be prepared for owner supplied and Brown's installed tile. Plumbing: We will disconnect all fixtures. We will supply and install a Sterling Tub and shower unit. 'EnebeWoke, We will supply and install a Symmons tub valve Model#S96-2 We will supply and install a Kohler 8"Forte lave faucet. We will disconnect and then reconnect existing toilet All work to be connected to existing plumbing.If any upgrades are needed a quote will be provided. Shower Door:None Heating:We will replace the baseboard heat.Installing it on the outside of the wall and patching the wall. Ventilation: .We will vent the existing fan to the outside. Electrical:None at this time. This will be quoted. *Tile quote is based on a straight installation.Intricate patterns are higher in price for install.Marble like tile is a higher price for install. *At tithe of job all knobs, handles, TP holders,towel bars etc.must be on.site for installation. If not on site(luring job installation a service.fee will be charged to return to job and install these items. Nothing other than stated above is included In this quote No paint orpaper.All sales tax Is included All work is fully Insured Any debris created by Browns will be disposed of by Browns.Local permit fees not included. 146d, -roAl aub lh.e.t + —10 0- NaiC S+w dar d l aw Door Style KI/)plm AGREED PRICE: $11,200.00 111 q OO — -T:q l j Cp b p,"& Handle/Pulls Floor 113 DEPOSIT: Counter (143a>U,GA BALANCE DUE: This quote.is.good.for(30)Thirty Days from date above. The owner represents and warrants that he is owner of aforesaid premises and that he/she has read this agreement,set forth on both sides. IT IS EXPRESSLY AGREED THAT NO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN, EXRESSED OR IMPLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTTWTES THE ENTIRE AGREEMENT. It is further agreed that this contract,is not subject to cancellation except by written consent of both parties. SALESPERSON: ACCEPTED: ACCEPTED BY: � X X (SUBJECT TO ALL CONDITIONS ON THE REVERSE SIDE) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizationMdividual):_?__XL ins KA16-h d F (11[It'p i S Ylt�rrnbtr� Address: 12 f4bil n l City/State/Zip: '_&ridtfs . MA blot213 Phone#: Clik 3333 Are you an employer?Check the appropriate box: Type of project(required): 1. C I am an employer with 3 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7. C4 Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. 66 Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance requiredf t c. 152,§ 1(4),and we have no 12. ❑Roof repairs employees.[no workers' 13. ❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. ` Insurance Company Name: P11f help ru�eGitM fir\s. Policy#or Self-ins.Lic.#: �1D�15 D�v LaU�t Expiration Date: l` 1 t Job Site Address: is 4 b[t{mp i c. Lamp. City/State/Zip: 11 Ar�wr✓r . LA R LN24-5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification I do herby certify under the pains.and penalties of perjury that the information provided above is true and correct. Signature: Y<,t Date: / b Print Name: t11t\e_ I l lt]V h Phone 9: C1 k 1-14- 3333 Oficial 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 Reath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: massstchusetts - Department of Public Safeth Board of Building Regulitiolps Construction SupervisorLcensettstlt�tl` License: CS 73375 di,r c,f BRIAN F MURPHY 11 KENMORE DR DANVERS, MA 01:923 *.4 Expiration: 9/3/2012 Coll] i+siwur Tr#: 1799 � �fre �oorinwouuectll� '.cuaac/ivaeCzd -\ Office of Consumer Affairs&Business Regulation VBMNHOME IMPROVEMENT CONTRACTOR Registration: V=1.p3611 Type: Expiration: -�{l9/4012 Private Corporatio -S KIT CR BRIAN MURPHY 72 HOLTEN ST. Danvers,MA 01923 Undersecretary „. ; ► I �I1:TI� Cly MA%. issuEs THE AOavE ueiN'sE Tc r aft ( iy ,.' 1 ACORD„ CERTIFICATE OF LIABILITY INSURANCE OP ID CR DATE(MWDDIYYYY) BFMURPH 09/13/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Wakefield MA 01880 Phone:781-914-1000 Fax:781-246-2601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arbeiia Protection Ins. (A) INSURER B: BF Murphy Plumbing & Heating, INSURER C: Inc &Browns Kitchen & Bath inc 72 Holten Str et INSURER D: Danvers MA 0123 INSURER E: COVERAGES 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. LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MM/DD EFFECTIVE DAZE MW DNY LIMITS GENERAL LIABILITY HEACHCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY 8500025389 06 O1 10 06 O1 11ES Eaoccurence $300000 / / / / ( )CLAIMS MADEa OCCUR P(Any one person) $5000 NAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 NENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY JR' Loc Em Ben. 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 A ANY AUTO 99770400002 06/01/10 06/01/11 (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-0OWN (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $1000000 A X I OCCUR EICLAWSMADE 4600025390 06/01/10 06/01/11 AGGREGATE $1000000 DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 9095020609 06/01/10 06/01/11 E.L.EACH ACCIDENT $500000 OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYE $500000 R yes,describe under SPECIALPROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION NORTH-3 SHOULD ANY OF THEABOVE 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 TD THE LEFT,BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover MA ACORD 25(2001/08) S RD CORPORATION 1988 OP ID CR E( ACORD„ CERTIFICATE OF LIABILITY INSURANCE PID CMMIDD/YYYY) PH DATE( 13 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Wakefield MA 01880 Phone:781-914-1000 Fax:781-246-2601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Arbella Protection Ins. (A) INSURER B: BF Murphy Plumbing & Heatingg, INSURER C: Inc &Browns Kitchen & Bath Inc 72 Holten Str. et INSURER D: Danvers MA 0123 INSURER E: COVERAGES 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. ON LTR NS TYPE OF INSURANCE POLICY NUMBER DOU ATE EFFECTIVE DATE MM/DDI YI LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY 8500025389 06/01/10 06/01/11 PREMISES(Ea occurence) $300000 CLAIMS MADE I OCCUR MED EXP(Any one person) $5000' PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 1-1 POLICY EJECT Loc Emp Ben. 1000000 AUTOMOBILE LIABILITY COMBINED BcDtSINGLE LIMIT $1,000,000 A ANY AUTO 99770400002 06/01/10 06/01/11 (Ea ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIREDAUTOS „ BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $1000000 A X OCCUR FICLAIMSMADE 4600025390 06/01/10 06/01/11 AGGREGATE $1000000 DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND X TORY LIMITS I I ER A EMPLOYERS'LIABILITY 9095020609 06/01/10 06/01/11 E.L.EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYE $500000 Hyes,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 CERTIFICATE HOLDER CANCELLATION NORTH-3 SHOULD ANY OF THE'ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAUL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover MA ACORD 26(2001108) RD CORPORATION 1988