Loading...
HomeMy WebLinkAboutBuilding Permit #278-13 - 20 HODGES STREET 10/9/2012 BUILDING PERMIT of No RTf{ qti TOWN OF NORTH ANDOVER ti _ o� APPLICATION FOR PLAN EXAMINATION Permit NO: �� (� Date Received 4°°�•°-°w•°• ' � �sRSSACHl15E��� Date Issued: `l I PORTA Applicant mustcom-p r completeall ai ems on�t this g e , -- " # < _ � PROPERTY , top s a` (� P � M PNO PARCZ0_ ING.S RJCT ,°} Histoic®isfnct`` " a Nono` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential f ❑ New Building bone family Addition - ❑Two or more family ❑ Industrial w ❑Alteration No. of units: ❑ Commercial -❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `'S p c Welly ® Fly o plaQk,W,ands i® UVatershed ®ict ' DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: f2 ill,- - AL �,e �,1-2�- Phone: ck-1 Address: NA • 4111 C®NTRA'CT® s v , t 3 R tN, ame ire° t . _ = s ; SupervisosCo.77 nstructionLcense { i t Exp _# ate4.t, y? r`sf� H-some I�mProvement Lcen OL '"�!L' Exp Dates ` ¢} ARCHITECT/ENGINEER , 41 _ Phone:-_q:lT- b Address: d uw l�p.wrZ ilr , �,.s�-meg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. J j Total Project Cost: $ k-4,, FEE: $ ,V Check No.: Receipt No.: ©2vr75�6 NOTE: Persons contracting with unregistered contractors do not have a cess to the guaranty fund ' . :(E Sig ure df-A ent/Owner z - � 9 � gnatu a---contract v ' Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F YPE OF SEWERAGE DISPOSAL ~ Swimming Pools � ❑ � ' blic SewerTanning/MassageBody Artell El Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ El i COMMENTS NATION Reviewed on Si nature CONSERVATION COMMENTS HEALTH Reviewed on Signature ` COMMENTS Zonin Decision/receipt submitted yes Zoning Board of Appeals:Variance, Petition No: g i Planning Board Decision: Comments i. . Conservation Decision: Comments Driveway Water & Sewer Connection/Signature&Date Permit DPW Town Engineer: Signature: _Located 384 Os oo Street' FIRE D.EP ARTMENT TempA®umpsteronife, yes ��aro -�' Locatedlamo Sheet` `� it�1�24Maint - o, 4. Fire department signature/date= _ - � - ffi ~ R r'. ( ()IVIIIIIENTS f Dimension Number of Stories:Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: Ll11 -7 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 r - r ❑ Notified for pickup - Date I � Doc.Building Permit Revised 2008 r 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of-H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract Li Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan _ ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑. Copy Of Contract ' ❑ Floor/Crossection/Elevation.Plan Of Proposed Work With Sprinkler Plan Anda Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) - o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 - ,r .werw3TG' - IE�I%,VIVIIVICIf�lla;�� -- Location �/�t,Y/` G S No. 2�71r-/ 3 D to S. e ' TOWN OF NORTH ANDOVER r_a •" 3s Certificate of Occupancy $ Building/Frame Permit Fee r Foundation Permit Fee $ . Other Permit Fee $ TOTAL $ _ u Check#//,�qS 25796 wilding Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 249500.00 m $ - $ 294.00 Plumbing Fee $ 36.75 Gas Fee 100 comm. $ 1100.00 Electrical Fee $ 36.75 Total fees collected $ 467.50 9 20 Hodges Street 278-13 on 10/9/12 Add 20x22 second floor to existing house NORTIy Town of E 6Andover No. P i,9. h ver, Mass, z2 iz COC NICNIw Crt �d AD4ATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT 9©h��'" ............. BUILDING INSPECTOR .. Foundation has permission to erect .......................... buildings on ..��?.�:7.�'... .. .l s.....��........... Rough .......02 to be occupied as ...........�c.C� G.f...............:5� .. .....��:............................................... 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 CONSTRUCTION STARTS Rough Service ...............:..... � ............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. SEE REVERSE SIDE C ` NOH RT Town of 6Andover No. — oN'; *. h ver, Mass, i- cocNIc"twIcM �•9 4 � U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT Re �°"� ............. BUILDING INSPECTOR .. Foundation has permission to erect ......... buildings on � . tobe occupied as ........... ��l�........ .f...< ......:Sw .. .. ��':............................................... 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 CONSTRUCTION STARTS 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. SEE REVERSE SIDE Ke, ��, 169 Boxford Street y"V/1 I M-u _ )___Y_ PH:978M8-6335 North Andover, A 01845 Building Contractor FAX:978-688-X)= Proposal To: Bob Albrecht 20 Hodges Street All Home improvement Contractors and Subcontractors home improvement North Andover, Ma 01845 specificallyexemptaged unless of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home From: Kevin Murphy Improvement1 i,t MA Registration,OneAshburton77 Place, CC: Date: 9/28/2012 Jolx Partial Second floor addition Date of Plans: 9/12 Architect: Steve Foster Location: Same Section 1-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 10/8/12. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 11/15/12.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11-Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall,at his own expense,forthwith remedy, repair correct,replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section III-Scope of Work Page 1 of 4 ar . Kevin Murphy Page 2 of 4 Building Contractor 9 169 Bo)dord street North Andover,MA 01645 PH:978-686-5335 FAX:978-6WXXXX General Proposal is to remove roof on existing single story section of house, and add bedrooms above, as shown on plans. Building permit to be provided by contractor. Building plans provided by owner. Proposal is to build addition to a"weather tight state"only. Demolition Roof on rear section of existinghouse will be completely removed and disposed of. Owner to remove existing P Y Po 9 chimney Foundation Existing foundation/footings to remain. Building All frame , roof, and siding materials will be supplied / installed to match existing / meet building code. Floor joists will be 2x8, exterior walls will be 2x6, roof rafters will be 2x10. Interior petitions will be 2x4. All floor, wall, and roof sheathing will be fir plywood ( 3/4 on floor, 1/2 on walls, 5/8 on roof) . Ice and water sheild will be installed at all roof edges. Roof shingles to match existing. Exterior walls will be wrapped with Tyvek or equivalent. Vinyl siding will be supplied (installed to match existing. Six Harvey vinyl windows will be supplied /installed to match existing. Items Not Included There have been no allowances made to provide any mechanical work, insulation,or provide any interior finishes.Addition will be built to a"weathertight state"only. Waste Removal Demolition/construction debris will be disposed of by contractor. I Kevin Murphy Page 4 of 4 Building Contractor 189 Boxford street North Andover,MA 01845 PH:978-6885335 FAX:978-6WX)= Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ...... ... ...... ...... ... .......$ 24,500 Payment to be made as follows: Percentage/item Description Amount 1 Permit obtained $2000 2 Roof framing complete $12,000 3 Windows / siding installed $8000 4 Job complete $2500 Total 4 1 $24,500.00 "Notice:No agreement for Hone improvement cortarling work sho regime a down payment(advance deposit)of more Ord one-fhad of the total cmUad price of the total amount of all deposits or payments which the contractor must make,to advance,to order arWor othervvise obtain delivery of Wesal oder materials and equipment,whichever is greater Contractor. Kevin Murphy 169 Boxford Street No.Andover, MA 01845 Registration No: 101874 Section V—Acceptance Acceptance of Proposal—I have read this document and accept the prices,specifications,and conditions stated. I understand that upon signing,this proposal becomes a binding contract You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature ,c.,�' A« Date ( Z t 2 Signature Date y L NEW DORMER. MATCH PROPOSED ( EXISTING. EXISTING. DORMER D.H. WINDOW 13'-9" +/- IF) 2'-0" 2'-0" 110'-6" +/-(VIF) 2:4•, BATH I I CL. 3'-0" (EXISTING) N L + `L - - I BEDROOM BEDROOM � CL, NEW DOOR EXISTING z NEW WALLS. I - CHIMNEY = SHOWN SHADED cv) 2'-0° Z p r(TYPICAL) 9 • ''9. ROOF--__,�\ ' - BEDROOM NEW DORMER. • 6•• 2s•• � ' 2 HALL I I REMOVE EXISTING DOORS J (EXISTING) MATCH J p EXISTING. JI i I Q Z > Q� NEW C.O. EXISTING o `+ —I STAIRS TO BEDRO M .,0CL. 1ST FLOOR .� - VERIFY STUDY DOOR HT. CL_ DO 12'-3" +/- IF) AT SLOPED ''9�� CEILINGS (TYP D.H. WINDOW SECOND FLOOR PLAN PLANS FOR ALBRECHT RESIDENCE 20 BELMONT STREET NORTH ANDOVER, MA SCALER/4"=T-0" DATE:9/21/2012 ` PROPOSED EXISTING - - - - - - - - - - - - - - - - - - - - - - - - - - - - - = EXISTING PROPOSED RIDGE VENT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ______ _f w NEW DORMER NEW DORMER NEW WINDOWS EXISTING ROOF STRUTURE SIDING TO MATCH EXISTING TO BE REMOVED. STRUCTURE BEYOND FINISH 2ND FLOOR - - - - - - - - -- - EXISTING WINDOWS FINISH 1ST FLOOR L J PLANS FOR REAR ELEVATION ALBRECHT RESIDENCE (PROPOSED) 20 BELMONT STREET NORTH ANDOVER, MA SCALE:1/4"=V-0" DATE:9/21/2012 OUTLINE OF EXISTING STRUCTURE (BEYOND) EXISTING ROOF RAFTER. FULL 2 X 5 AT 16"O.C. FINISH 2ND FLOOR 1 EXISTING WALL. LOAD BEARING WALLS. (V.I.F.) PORCH KITCHEN DOUBLE 2 X 6-""N\ FINISH 1ST FLOOR EXISTING POURED + CONCRETE PIERS. APPROX. 12" DIA. X 3'-3" EXISTING FIELDSTONE FOUNDATION. 2X6AT18"O.C. +/- FINISH GRADE PLANS FOR ALBRECHT RESIDENCE TYPICAL CROSS SECTION 20 BELMONT STREET NORTH ANDOVER, MA (EXISTING) SCALE:1/4"=1'-0" DATE:9/21/2012 r FRAMING CONNECTOR. RIDGE VENT BEAM TO RAFTER 2 X 10 AT 16"O .C. ASPHALT SHINGLES.MATCH EXISTING. 5/8" EXTERIOR PLYWOOD DECK ALIGN NEW ROOF STRUCTURE WITH EXISTING R-38 INSULATION. 2 X 8 AT 16" O.C. GWB ON 1 X 3 STRAPPING INSULATE FULL DEPTH OF FRAMING. ALLOW AIR SPACE ABOVE. TYPICAL EAVES DETAIL: FASCIA& SOFFIT TO MATCH EXISTING / X FRAMING CONNECTOR CONTINUOUS SOFFIT VENT 1g W WALL TO RAFTER DOUBLE TOP PLATE �� f v METAL DRIP EDGE ICE/WATER SHIELD < R-21 INSULATION OUTLINE OF EXISTING 3/4"T&G PLYWOOD DECK. STRUCTURE (BEYOND) z NAIL& GLUE TO FRAMING KNEE WALL; 2X4AT16"O.C. U INSULATION BLOCK DBL TOP PLATE. INSULATE FULL DEPTH FINISH 2ND FLOOR OF FRAMING _ + PROVIDE NEW HEADER INSULATE RIM JOIST EXISTING WALL. EXISTING LOAD NEW FLOOR FRAMING. V.I.F. HEADER& BEARING WALLS 2 X 8 AT 12" O.C. WALL STRUCTURES. (VIF) 3/" T&G PLYWOOD-NAILED &GLUED MODIFY AS REQUIRED. I PORCH KiTCHEN NEW BEAM 14' -2" +/- EXISTING POURED FINISH 1ST FLOOR CONCRETE PIERS. + - - APPROX. 12" DIA. X 3'-3" LALLY COLUMN POST. EXISTING FIELDSTONE FOUNDATION. FINISH GRADE PLANS FOR ALBRECHT RESIDENCE 11 20 BELMONT STREET 2 X 6 AT 18" O.C. +/- NORTH ANDOVER, MA SCALER/4"=1'-0" DATE:8/15/2012 TYPICAL CROSS SECTION The Commonwealth of Massachuseft Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibiy Name(Business/Organization/Individual): ��pit/l w+ �'wW�-m �►--•� �; � Address: City/State/Zip:ta, A ea k.9, " Phone#: 0t,'1 $� vCT °a 313 Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with \ — 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ? E]Remodeling 2.ElI am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These subcontractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 914Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their right of exemption per MGL 11.❑plumbing repairs or additions 3.F1 am a homeowner doing all workp p myself.[No workers'comp. c.152,§1(4),and we have no 12.(]Roof repairs insurance required.]t 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. l Homeowners who submit this affidavit indicating they are 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-contractors and their workers'comp.policy information. tam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: i�s�,��,.-o� �la�+� ` � 1 Policy#or Self-ins.Lic.#: �C.- tivC- 3a L-1 9)d-D Expiration Date: `1`k\dI �'� W City/State/Zi e,►.�. GA0111"i h`°— 01iGu� Job Site Address: �� l�d��'� C p' 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 c.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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. l do here cert under the pains and , fltiesvfperjury that the information provided above is true and correct Si afore: Date: a <Z Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License I 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#• DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/7/2012 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 Astatement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). y PRODUCER NAME: M P Roberts Insurance Agency Inc a°No,Ext: 978-683-8073 FAX No):978-683-3147 1060 Osgood Street ADDRESS: sandi@mprobertsinsurance.com North Andover Ma 01845 INSURER(s) AFFORDING COVERAGE NAIC11 INSURERA: PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B: MERCHANTS INSURANCE 169 BOXFOR0I STREET INSURER C: GUARD INSURANCE INSURER D: NORTH ANDOVER, MA 01845 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. INSHUUL;y EXP rnR TYPE OF INSURANCE IADDL SWVD POUCYNUMBER (MM/DD/YYYY) (MM/DDAYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 ICLAIMS-MADE X I OCCUR MED EXP(Any oneperson) $ 5,000 A CPP0060868 1/22/11 1/22/12 PERSONAL BAOVINJURY $ 1,600,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY JE Q LOC $ AUTOMOBILE LIABILITY 1,000,000 Ea acddem $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED MCA7013608 01/23/12 01/23/13 BODILY INJURY(Per accident) $ B I AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION $ $ li WORKERS COMPENSATION X I WC STATU- YOTH- AND EMPLOYERS'LIABILITY TIN ORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUnVE ❑ NIA EL. ACCIDENT $ 500,000 C OFFICERIMEMBER(MndatoryI.NH)[7(CLUDED? KEWC,317800 07/01/12 7/01/13 E.LDISEASE-EAEMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional RemarksSchedule,il morespace is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REP VE 4 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD