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HomeMy WebLinkAboutBuilding Permit #513-2011 - 2 JOHNSON STREET 12/30/2010Permit Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION -' IMPORTANT: Date Received must comblete all items on this LOCATION c;:2-4/ Print PROPERTY OWNER (� �e e- Z e(+ L+ t 2 �� Print MAP NO: PARCEL: :�?ZONING DISTRICT: B `/ Historic District C�yss no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Ad ition Iteration ❑ Two or more family No. of units: ❑ Industrial P-f�-.Ommercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition11Other r �I `ptics ❑1Wellx �❑ Se �iFloo$pOhWeLf v t w - lam I _ tlands+ = `®, W tershecitD ictf _ ESCRIPTION OF WORK TO BE PERFORM D: I cK n.e,�.- l -T v P '� R C+-6=tiyse- eew►,` ee �Q�+-to 1Co44 ©-y�- (w 8 L �', e- 14, 4 h e e o% s. 1410 4 G"i P feeyt'Ov-s l t/ Lss u as-)• A&L-4. two 2 k to V;y L a tecf ae-4L, tyob b 94 4c . 11Ide tification Please Type or Print Clearly) OWNER: Name: C' e wee e ra L Te- v 1 - Phone:S 01�- 3a$- , 50 Address:1-2( SO L e, � ee-o : Pod, W-11 oyt2 614 0i$Y� CR%c[&cLvo0rA c�r-�r.� -b64 Ke -V - 1-/w 111 C ' �7�-1Ooa-3/6,3 CONTRACTOR Name: a u, 6M 4 K (f . s G -yo tL T 2us-fr- e Phone:.CU9 3;8 -080 Address: & q ©�� f �i'GL �N ��. /�o e�4-� I "0' r?, - )Q, m 4- ©k494 Supervisor's Construction License: C S 7t;-30.2- Exp. Date: /.2 /Y fro / I -- Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER0 vLU�oon i���,��c'� Phone: Address: X80 M4Z,,t �+, ee, 41 ', G- m 14 Reg. No. &0//0 FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �-�i FEE: $ �7? %�— Check No.: F07 ? Receipt No.: 2 NOTE: Persons contracting with unregistered contractors Tot have aceessrto-tie uaran and eof �4aent/Owner�' .� ,. If Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer u 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 COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS 1 0 V►� °�) 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 l �� d�z�l d 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.$10041000 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 g 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) ❑ Muss 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 VOTE: 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 hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording gust be submitted with the building application Doc: Doc -Building permit Revised 2008mi Location No. 3 _2 ��� Date 2 3v TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��s.�•�„s<� Building/Frame Permit Fee $ Check # Ro % 7 23€'/-7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector W c o � c •. c t5 1� H � O Q C.7 r n 0 0000 "1 w SIR O L `>� Ea T _m XX CL 'CO O rl:_ Q� � � a � �'• O m * tsC" O amtec E a. mm a C H y o 3 s O c y.+ � O H - \=m y O O cm :mo y m ; o c y a 2O CL, m O OC 13 ma `o vi ..` c CL O c c F- . z NJ O � ~ C = w F. •tA • •d0t O.c Z myCO VV® m O �O ti am _Goa `H O `w -mz = w CL O CD O CD .S v Z O h � O W tm I O Coo CD M�� M� •7E W W a~� = 3� OCD Lft CD CD 0 O cc oa CL to o � c cc .Q O D C CL :..± VA O O CL C •� C ev � H uj U) 19 W ce ,ul W,ww Y/ Ow 0.4 44 o a o� c� a w z Q `toa Q o\ -o W o -�- o , 1 o U cn cn W c o � c •. c t5 1� H � O Q C.7 r n 0 0000 "1 w SIR O L `>� Ea T _m XX CL 'CO O rl:_ Q� � � a � �'• O m * tsC" O amtec E a. mm a C H y o 3 s O c y.+ � O H - \=m y O O cm :mo y m ; o c y a 2O CL, m O OC 13 ma `o vi ..` c CL O c c F- . z NJ O � ~ C = w F. •tA • •d0t O.c Z myCO VV® m O �O ti am _Goa `H O `w -mz = w CL O CD O CD .S v Z O h � O W tm I O Coo CD M�� M� •7E W W a~� = 3� OCD Lft CD CD 0 O cc oa CL to o � c cc .Q O D C CL :..± VA O O CL C •� C ev � H uj U) 19 W ce ,ul W,ww Y/ tN W Cd F 1 y y .� L - CL O C 0 CD V _cc ME CO) ca0 Q.. H O O C _cc CL COD CD CD 3 �CD D L O C' o�Q c� _c/am� •Y J 00 O O Z C.3 C. CO2 C D U) LLIU W LLI V9 LU ,,Www c/ s ui � z mc CD ZW C=* c w w a � U : �•, C O x � V V U) zZ4 a U:• L cc w 0 +- m _1 0 a- !�• co A ' y E a z Z u A s 0 CL. w C• � c ' o v w �u w z Q ti. my c E opa w v m v v o CO O w vO Cf) O q a U w O G a w" O G u: cn r3. O G cw u. m O w cn 0 cn 1 y y .� L - CL O C 0 CD V _cc ME CO) ca0 Q.. H O O C _cc CL COD CD CD 3 �CD D L O C' o�Q c� _c/am� •Y J 00 O O Z C.3 C. CO2 C D U) LLIU W LLI V9 LU ,,Www c/ s ui � z 1 y y .� L - CL O C 0 CD V _cc ME CO) ca0 Q.. H O O C _cc CL COD CD CD 3 �CD D L O C' o�Q c� _c/am� •Y J 00 O O Z C.3 C. CO2 C D U) LLIU W LLI V9 LU ,,Www c/ mc CD C=* c : �•, C O � V V U:• L cc 0 +- m _1 0 a- !�• co ' y E a 0 s 0 CL. y vE= C• � c �u cm ti. my c E v m d. V. CO IAA C42 C m ca •_ .• m p I: v y CC R O m o CLC-) L O cm0 m �i C � O C O�-c 8 32 � `V .2 �•N O V: �Z i O CO cm d O C •O Q m C = m o y m CD .y MD cc F- ccc ca .m CO CZ 'r m •y O cW.3 o ® c H Vo _ CL H •� CD 40- CLmZIN 1 y y .� L - CL O C 0 CD V _cc ME CO) ca0 Q.. H O O C _cc CL COD CD CD 3 �CD D L O C' o�Q c� _c/am� •Y J 00 O O Z C.3 C. CO2 C D U) LLIU W LLI V9 LU ,,Www c/ 9864 Date ... ......`1..1 Y...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. ......... - r...,/ `............. . ............. has permission to perform .':::.............. �. 5 . r .. .........1 wiring in the building of .... � . �� . �`.:..�:r........ !... !`. -........ i,at ... ..`..z ............f ..........fesL 'North -Andover, Mass. { Fee ... 2. �— --��4'c. No. f l` ............... :.c�. Irrseecroe }� Check # / Z / 7 � -� C'u' 'Onwealth Of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official t i -w Qnty Permit No. L z Occupancy and Fee Checked FRev_ is"07� (lvc blank} _— APPLICATION FOR PERMIT TO PERFORM ELECTRICAL R All work tt) be; pe:rto meed in accordance with the Massachusetts Electrical G WORK f1'1,EA.S'E PRINT W INK OR TYPE ALL INFORMATION "1(htEC}' 27 CMR i ?.t)t) City or 'Tovvn of: NORTH ANDOVER ) Date: /e�--- To the Inspector of Wires: t3y thi + applicatton the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 2 Owner or Tenantv4(« f 7/l' 61 1' . Owner's Address p Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of Building �NO El(CheckAppropriate Box) a y Utility Authorization No. Existing Service Cl Amps 1,7-_ 12y, & Volts Overhead f;'�, find d L-7- :1 NeKn Service Amps / _Volts Number of Feeders and Arnpacity 1.,0c3tion :and ?`nature of Proposed Electrical Work: gr Overhead Undgrd table No. of ;Meters � No. of Meters oG waive theinspector oHire. ata -" ' KVA KVA EIRE ALARMS No. of Zones o. a etectaon gnu Initiating Devices No. of Alerting Devices No. o e - ontaene Detection/Alertiatg Devices Local ❑ .vtunactpal Conneetinn ❑ Other -^ f)e, Data Firing: No. tttnc.h r:ri(latwnal detail if'el4sirecl, rye ns acrttaireci h tht /,ts� rc'trar,aJ'tt"reeve i stteraated Value,,,t t 1t:ctrtcai Werk: Work to `t:art: � - t , - - - (When rewired by ztitanicipal policy.') l/ inspections to be requested in accorda"Ce with MEC Rule it), and upon completion. iNSUR,rA�*e(��i: f"1 iIERAGE: Un waived by the owner, r10 pemlit for the Performance ofclectrical work may issue unless tine iicvTlwc provides pr« c)f'of liability insurance including "Wilipleted oration" coy, , und:.rtiff,ned ccrttfscs that such coverage is in force, anlavas exhibited proof of same to the pemil.t issuirlofficeuivalertt. The C'IM"C K ONE: ll` SURANCE()Np ❑ OTHER 0 (Specify:) l c e rtify, tinder the pains and penalties ef'perjuM that the infFIRM NAME-.ormation ars this application %} true and eetmplele. Live "see: � 1 I.IC. `=` � .-- — _ Signature 'ever+z{�t nr tlir licence uumher li ?ej r LIC. NO.. f 47 s. 5f-61, — A Bus. s�1o.:. security work requires ,Aft. Tel. No.: OWNER'S INSE RAMC F, WAIVER: i sen aware that�[h� I...iccn,c ohne slic �rr t have the lin ie " t_lC. N41. required by law. lay nay'i9tidture tx°luw, i hereby waive this requirement. ! tftrl file (Liaz,ck ,I it b Iffy insurance cavera,�e normally i}}�ntr/,'.gcaat ) ❑ ttaner owner', agent. -- - Telephone No. I PER.UIT FEE_ $ No. of Recessed I,umsnairesa-vm trtivn v the v1lvNitr yl No. of Ceil.-Susp. (Paddle) Fans No. of Luminaire Outlets No. of Hot Tubs No. of Luminaires Swimming Pool Above n_ El ❑ No. of Receptacle Outlets z aNo. end. end. of Oil Burners No. of Switches U No. of Cas Burners No. of Ranges No. of Air Cond. ota No. of waste Dis users p Tons eat ump um er ons Totals.• No. of Dishwashers / SpAce/Area heating KW No. of Dryers Heating Appliances VV Ater Kyt,, lleatea'S l�iW -- Signs Ballasts No. llyd€csasaascal a Bathtubs No, of motors Total HP t31'iIER: table No. of ;Meters � No. of Meters oG waive theinspector oHire. ata -" ' KVA KVA EIRE ALARMS No. of Zones o. a etectaon gnu Initiating Devices No. of Alerting Devices No. o e - ontaene Detection/Alertiatg Devices Local ❑ .vtunactpal Conneetinn ❑ Other -^ f)e, Data Firing: No. tttnc.h r:ri(latwnal detail if'el4sirecl, rye ns acrttaireci h tht /,ts� rc'trar,aJ'tt"reeve i stteraated Value,,,t t 1t:ctrtcai Werk: Work to `t:art: � - t , - - - (When rewired by ztitanicipal policy.') l/ inspections to be requested in accorda"Ce with MEC Rule it), and upon completion. iNSUR,rA�*e(��i: f"1 iIERAGE: Un waived by the owner, r10 pemlit for the Performance ofclectrical work may issue unless tine iicvTlwc provides pr« c)f'of liability insurance including "Wilipleted oration" coy, , und:.rtiff,ned ccrttfscs that such coverage is in force, anlavas exhibited proof of same to the pemil.t issuirlofficeuivalertt. The C'IM"C K ONE: ll` SURANCE()Np ❑ OTHER 0 (Specify:) l c e rtify, tinder the pains and penalties ef'perjuM that the infFIRM NAME-.ormation ars this application %} true and eetmplele. Live "see: � 1 I.IC. `=` � .-- — _ Signature 'ever+z{�t nr tlir licence uumher li ?ej r LIC. NO.. f 47 s. 5f-61, — A Bus. s�1o.:. security work requires ,Aft. Tel. No.: OWNER'S INSE RAMC F, WAIVER: i sen aware that�[h� I...iccn,c ohne slic �rr t have the lin ie " t_lC. N41. required by law. lay nay'i9tidture tx°luw, i hereby waive this requirement. ! tftrl file (Liaz,ck ,I it b Iffy insurance cavera,�e normally i}}�ntr/,'.gcaat ) ❑ ttaner owner', agent. -- - Telephone No. I PER.UIT FEE_ $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR - DOUG SMALL L ROUGH INSPECTION: Passed Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: ' Signature - no initials),Date 2. FINAL INSPECTION: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ ] Inspectors' comments: "I j1 - no initials) Date 3. UNDER GROUND INSPECTION: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - [ Inspectors' comments: I kiLubp turn- signature - no initials) Date 4. INSPECTION — SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) - Inspectors' comments: 'Signature - no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE -INSPECTION OF $50.00 IS TO BE CHARGED. 74°1 WORTH 3 Date.' d' l ///....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...,!� f ! e:.�. 4 ... has permission for gas installation . � . � ` . � ...:. `.- :'. � ....... in the building of ...�.../� �-t : �f! ................... at :..`.....`.... `.`. ! ....... G `- ..... , North Andover, Mass. Fee. 9-f .... Lic. No........�........... GASINSPECTOR Check # 735 ? f I FIXTIIRFS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: AAL/" MA. Date: 7-10 Permit# Building Location: CG - h S7 Owners Name: Type of Occupancy: Commercial M Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ New: ❑ Alteration: ❑ Renovation: ["/ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTIIRFS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes R No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy .E� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner [:] Agent [j By checking this box ❑; i hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and a..Ul— W UJU uVaL LPI lily nnumeoge ano mat an pmmomg worK ana installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: ❑''dumber Title El Gas Fitter ['tester Sig ure of Licensed Plumber/Gas Fitter City/Town ❑Journeyman v F APPROVED OFFICE USE ONLY El LP Installer License Number: 1�_ X WFW- W Y Ui Z Q to O W U H 2 X MX o z lX W U' Z J p V } 0 U) w Z w O= O W N W �, W W z m 0 0 Q W a. O ►- Q F o W a W X = u > t- U) U W () W z en W '� H Z t- O z w Z W J U' t- W W Zww W W W W Z U W? D: J Q 2 Q Z m w O O z a>>> 0~ Z F 'S O t=i UQ' (�9 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4rH FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company //�� /f ��J ` ! Check One Only Certificate # Name: l`7 ti wS w �rporation 3 C � < a�r�t""���� Address: P-0., r' 1-76 Cityrrown:_� State: fm El Partnership Business Tel: Q [ 3-)u- 00Fax: g %�'s� i`" � 3 ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes R No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy .E� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner [:] Agent [j By checking this box ❑; i hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and a..Ul— W UJU uVaL LPI lily nnumeoge ano mat an pmmomg worK ana installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: ❑''dumber Title El Gas Fitter ['tester Sig ure of Licensed Plumber/Gas Fitter City/Town ❑Journeyman v F APPROVED OFFICE USE ONLY El LP Installer License Number: 1�_ z 0 K U W F. W�W P4 C7 O rs: a c� E - w z � o � � o w El p zi ca7 z C7 6s ¢ w vz� H W z z H U x z w Zi W.; � u °o w cn O U ►'1 '�q w w U w 0 E U w w O w w cn w p w iL4 H w w cn — o cn . c o `m c p CIS o ` N Oc C ycc O tj V CL O c0 O L m • � N ,� CD c O O 0 O. . 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Qo 7 � � Q 7� Q O L+is , O ;' a O � 11'ti a � � -� cn Q� U yq as Z N O '" U M n 75 O ^d U V 00 � o .,.-� 4-4 O o E-+ ►--1 p z o0 08/09/2010 13:10 9786833147 PAGE 05/05 �c CERTIFICATE OF LIAIBILITY INSURANCE8 9 10 °`mft-fm fft� - L THIS CERTi ICATE IS ISSUED AS A MATTIM OF. 011FOIRIUMM ONLYOW CONFERS NO MMM UION 7M CET't71FICATE HOLDER. THIS CERMFTCAM D= NOT AFFIl111AXIIEMOR MMTW Y AMISIVEMND OR ALTER TIM CWHiAGE AFFORDED By THE POLICES MOW. THS CMUMCATE OF NSl PMM DOES PDT CONB'TI V A CONTRAM BETWEEN THE WtXNG IN.SURER(S), AiTHOFaMD R NiAMVE OR PRODUCER. OND IME CE'IRCATE HOLDER:.;: VAPMTAW- if the ceDon w mnat be endWee& It SUBROGARON IS WXWE1 , sruifjaFtD tto hn., a W xnditm of the pollen *mU* pofklea melt "kpdre e1n ndo�a+Ylard. A etefti tent ort tKa certificate dues not coma; rimu to to cm oficaw holder io aeu of such �oDucaL ? .l M.P. Rabsrts Insuurranc:e Ageacg 978 683-8073 (9-1-0) 663-3147 1060 Osgood strut 2316 .yp�Ip��AI�OF�OR� COM$'AGE NWG!! 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AOOREOATE $ 2 000,000 GWLAC-CPMATELDST APPLIE$PER PRODUCTS-CONPR7PAQG $ ==,WE ? POLICY PRO LOC 6 AUiCa1GES"L1A8QliY COW WMSINTdLELNrr 6 At IYAU"ai BODILY q1A "(Per paleoll) 6 � ALIOWWQAtrM$ DWILY MURY (Per eCaCenq S F1L�lA$AIJTT)S H�£DAVMS NON-01MIED ATJT08 - ski PROPERTYDAFMQE ; (Pereaua�q Ir1013LAui19 EACHOf7Ctr�iFNCE S sumACLr � DS)UCT161E ``" ' j ¢ RETHYnON B YYtRi1Q3 CCNF"SATTONOTH- AND EMPLDYGM UAWLRYnFR �'^' � Y'N -9kt ErGLWm? later In � P eO TFONOF01�ERr4TIOkSbebw N/A 11=0075810120 ',`�' 9 ; . 9/2.5/09 9/15110 EL.EAOHAcaCENT $ 1,000,000 F_L.0MEASE.EABIBLDY i 1,0004000 EL. DISEASE- POLICY turr s 1,000,000 oEscwPrtDNVForeRanoNarLocaT10Nsrvaoa ~A0M1'H,A0doWP* 9*AdW.WWffi.peaerroquNq L ACORD 25 (20091091 The ACORD rartw and •y ,�a,aiva Awrau k-AAQ�u► I LUN. All ngnp MerYeO. Iogoa(te:cegaMered marks of ACORD I� SHOULD ANY OF THE ABOVE DESCRIBED ROUCMS BE CANCELLLED REFORi; { THE EXRRAIM DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE" INE POLICY PROVISIONS. :11 AlflrrpltP� 9EN7ATNE A40 ACORD 25 (20091091 The ACORD rartw and •y ,�a,aiva Awrau k-AAQ�u► I LUN. All ngnp MerYeO. Iogoa(te:cegaMered marks of ACORD I� Nlassachusetts - Department of Public Safch Board of Buildin- Regulations and. Standards Construction Supervisor License License: CS 75302 BENJAMIN C OSGOOD + . 69 OLD VILLAGE LANE' NO ANDOVER; MA 01845 Expiration: 12/4/2012 ('unnuiss7uner Tr#: 6267